Home Birth Bags

What the Heck Is In Those Bags?

Hi everyone! I was doing inventory the other day and decided to take some pictures of the contents of our bags (and supply closet, but thats boring) for our own reference. It occurred to me that, since folks always wonder “WHAT DO YOU BRING TO A HOME BIRTH?”, I could share the pictures with you! As you look through these pictures, keep some things in mind:

1) since we share this bag between three midwives, midwives with different habits and histories, we endeavor to keep it simple and streamlined so that it works for everyone. Assistants and nurses also get in to the bag, so it has to be pretty simple.

2) the idea is that this bag is ready to go for two births, and two births only. In my experience, midwives run in to a lot of trouble overstocking bags. Items expire, things get lost, and you can’t find the thing you need. Ideally, immediately after a birth, you re-stock it. These pictures were taken a couple days after a birth.

3) We have all home birth clients order this birth kit. The kits have a lot of stuff that we use at every birth (and plenty of leftovers as most of our clients know).

4) We have standing orders in every chart and nurses to administer meds. More on that in the meds bag section.

Without any further ado:

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Our Bags

This is pretty much it. The large purple home birth bag, the small meds bag, a personal bag (this one is mine - Adrianna and Marinda have witchy baskets - and the postpartum bag. Not pictured: sump pump and antibiotic kit.

The meds bag is separate so that it can easily come inside and never lives in a car even for a few hours. The personal bag holds midwife gear like a computer, change of clothes, toothbrush, chargers, midwifery stuff used by that particular midwife only, etc. Finally, we toss the postpartum bag in the car, usually, because it has some things we don’t have duplicates of like a Massimo pulse oximeter we use for CCHD screening and newborn resuscitation. If anyone out there feels the call to buy us a duplicate, we would not say no!

The Main Bag

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Main Bag

Top pocket is a ziploc “go bag”

This is the Main bag, an Iron Duck medical bag made especially for midwives. The top pocket has a ziplock bag that, say, we arrive at a birth and the baby is coming, we could dump out on a chux pad and have pretty much everything we need.

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Ziploc Go Bag

I like Ziploc bags because we can replace them frequently. I often replace them at births or when doing inventory. I love these large bags from IKEA

contents of the “go bag”

contents of the “go bag”

1) Doppler - for listening to the baby’s heart rate

2) Doppler Gel

3) Bulb Syringe (rarely) used for suctioning baby

4) blood pressure cuff, standard size

5) cord clamps x2

6) stethoscope

7) Sterile OB pack with 2 clamps and 1 scissors

8) sterile gloves, size medium x4

9) sterile gauze x4

10) sterile lubrication

11) flashlight

12) emergency blanket

13) hand sanitizer

14) inventory card

15) single use emergency meds bag

16) thermometer

At every birth we assemble a bowl or tray for our use. From the “go bag” bag we take out the BP cuff, stethoscope, doppler, gel, flashlight, OB pack and thermometer. The rest of the supplies we put in our bowl come from your birth kit. Sometimes we will use the items in the “go bag” at a birth and then replace them with items from your kit. The items we take out get sanitized after a birth before they go back in the bag. The OB pack instruments go back to the birth center to be sterilized. The goal is to keep everything clean, new and in-dates, ready to go.

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Bottom Front Pocket

or, the big, bulky, miscellaneous pocket

please excuse the picture quality change. I came back to the inventory later in the evening so the light is not as good.

please excuse the picture quality change. I came back to the inventory later in the evening so the light is not as good.

The outside bottom pocket is where we keep big, bulky items that we frequently use.

1) Sharps container

2) non-sterile gloves - there are about 50 of these in every birth kit, but sometimes we need more.

3) Fetoscope. When/if dopplers fail we always have this back-up (along with extra batteries)

4) Extra instruments and sterile field

5) Extra gauze and sterile gloves. It feels like there are births where we use none of these items and births where we use everything in your birth kit, plus our extras and start raiding the postpartum bag.

6) Duct tape (see birth tub bloopers)

7) Inventory card

Not numbered for some reason: bag with baby scale and sling

Not pictured: large blood pressure cuff

Opened bag

Opened bag

This is the bag just opened up to the main compartment. The pouches are, from the left:

1) Lab Bag

2) Suture Bag

3) IV start kit

4) packing

5) extra IV supplies

6) Amniotomy and Catheters

Lab bag contents

Lab bag contents

We don’t draw labs often at births, but it happens. Here we have, again in bags that can be replaced frequently (vs plastic boxes or cloth bags):

1) Draw supplies - needles, bandaids, alcohol, etc.

2) specimen bags and 3) paper requisition forms

4) and 5) - supplies for labs like urine cultures, glucose, blood type, CBC etc.



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Suture Kit!

Simple and effective

In my previous partnership in St. Louis, I was always the midwife who sutured, and I enjoy doing it when it is necessary. Over the years I have pared down the suture kit quite a lot, so that it is simple, streamlined and works perfectly, even when I am tired.

1) Suture kit (high quality needle driver, scissors, hemostat and needle puller) and sterile field

2) Sutures - Vicryl CT-1 3.0 x2 and SH 3.0 x2

3) Lidocaine x 2

4) 10ml syringes

5) 1.5” 22g needles

Unnumbered: recticare

And thats it!

What you need to start one IV

What you need to start one IV

This is a basic kit to start an IV. Again, we like to keep it simple so that this bag can be grabbed and, without a lot of thought, an IV can get started. Simplicity is even more important since we have nurses from different situations and everyone is used to different equipment.

1) IV catheters - 22, 18 and 16 gauge

2) IV start kit (1)

3) Bag of LR

4) Extension set x2

5) Administration set

Not pictured (remember I was doing inventory) suresite bandages, large, IV flush

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Extra IV stuff

more is in a separate kit that is used when people want antibiotics for GBS

This is a bunch of extra IV stuff. Not too much, nothing is more irritating than overstocked bags.

1) IV flush x4

2) Extra catheters

3) extra extension sets

4) extra connectors

5) extra suresite bandages

6) extra administration sets

Not pictured - extra LR and D5 (inventory day!)


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super fun stuff

is not located in this pouch


We do not break water very often, and we really don’t use catheters much. This pouch is for items that are long, narrow and sterile. (and there is a lot that needed to be restocked here)

1) self catheter x2

2) Amniohooks x2

3) Straight catheter x2

4) foley catheter x1

Not pictured: amnicators

Under all of the bags and pouches are other compartments where we keep less medical items.

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Tinctures

Adrianna makes many of these

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Little bottles

used occasionally….

Under all of that is a large compartment with resuscitation equipment

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back compartment

folksy heating pad cover

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A cutting board!?

whatever is that for?

I think every home birth midwife has a cutting board in her bag. This is ostensibly for resuscitation, and we set it up at every single birth. Over several hundred births, however, we have only used it once. Maybe twice. Meaning, resuscitation is usually brief and in the parent’s arms. But we have it, and it is set up with the heating pad and warm towels so that it is ready when the baby is born. At the birth center we have a Resus-A-Cradle.

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Newborn Resuscitation

stuff here

These are the things typically used for newborn resuscitation. Everyone at every birth is certified in NRP, though it is rare for low-risk newborns to need more than a couple inflation breaths at birth. We check and assemble items here when we set up for a birth. We make sure the bags and masks are working properly, and check to make sure other emergency items are available.

1) Self-inflating bag masks in various sizes

2) ziploc bag with small resuscitation items (gastric tube, Laryngeal Mask)

3) self inflating bags (these get tossed if we use them)

4) oxygen masks for newborn

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Adult O2

or, when room air is not enough

Stuff for adult oxygen

1) oxygen regulator (this opens the oxygen tank and delivers different amounts of oxygen - not to be confused with an oxygen mixer, which would deliver O2 at different percentages)

2) Medium concentration masks

3) High concentration masks

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A tank of O2

this tank will deliver oxygen for an hour. If we are at a rural location we can bring an extra tank.

That almost concludes the birth-bag tour. There are some additional odds and ends under the oxygen equipment, including some rarely used emergency supplies and rarely used instruments.

The outer back pocket has a file folder with actual paper in it. If clients do not have internet, or our computers die, we have back-up charts in here. We also have some diagrams and flowcharts that can be helpful at certain births.

back up paper

back up paper

Meds

Meds laws are funny in Virginia. With the support of physicians and CNMs, we have standing orders for all meds for every client in every chart. We have a nurse available for every birth to administer meds. We hope these laws change sometime soon, as Virginia is unique in licensing midwives and not allowing them to administer the medications that are in our scope of practice. These are all relatively simple medications and are the standard of care in our community for every birth. The cornerstone of our practice is informed choice - we work hard to offer the standard of care as an option for everyone. Some of these medications are lifesaving and we believe that it would be unethical to attend births without them.

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Behold, the meds bag

Separate from the birth bag so it never sits in a car

I like to hand this bag, pretty side facing out, from a door frame or closet

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Medications are in labeled plastic med bags with lot# and expiry if they are taken out of bottles

Row 1) OTC tylenol PM, OTC Ibuprofen, OTC benadryl

Row 2) Alcohol swabs, bandaids, (under the glare) misoprostol x

Row 3) Pitocin x4 (had just used pit at a previous birth), Methergine

Row 4) filter needles and small needles for vitamin K, Vitamin K

Row 5) 3ml syringes and 22g 1” needles and 1.5” needles

Postpartum Bag

There are some extras in this bag that I suppose we might occasionally use. But mostly we carry this so that the Massimo lives in one place. We take it out and have it with our resuscitation equipment. It goes back in the back for the CCHD screening at the first postpartum visit.

We love you, Rad 5

We love you, Rad 5

And that concludes the tour of our birth bags. If you are a client, student midwife or a doula, we hope this was helpful - now the heavy purple bag is a little less of a mystery. Let us know in comments if you have any questions!


Birth Tub Bloopers

A few months ago I brought you a story of the trials and tribulations of finding a birthtub for the birth center.  If you haven’t checked it out, you can read it here. I am happy to say that we have an Aquatica pre-ordered for the new birth suite. But what about home births?

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What could go wrong?

not much but…..



In Richmond, many folks have had babies at home with Adrianna or Nancy using the horse trough birth tub.

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One option

Horse Trough

The vast majority of folks planning home births in the US, however, use an inflatable tub.  At River City Midwifery we have one of these (big) and two of these (smaller) for our clients to use at home. Sometimes people will plan to use a garden tub they have at home or skip the water birth plan completely. But most of the time, one of these is part of the equation. Inflatable tubs have some advantages over other birthing tub options - they are super comfy, somewhat translucent (better pictures) and, because they deflate, they are portable.  Unlike built-in tubs they are harder to keep warm, sortof a pain to drain, but for the most part they work fine. We’ve been doing this a long time and have a system practically guaranteed for success.

But, over several hundred births there have been a few….. shall we say…. Bloopers.  And I am here today to share them with you.


Birth tub problems

A question on a lot of people’s minds, definitely a question on more Dad Minds than Mom Minds, is the safety and reliability of the old inflatable birth tub. I would call some people (men) Tub Skeptics.  And although Inflatable birth tubs are usually filled, used, drained and deflated with no issues whatsoever, there’s always a little element of truth feeding any skeptic mind.


Filling with Air

If something is inflatable, it will eventually leak.  Balloons, rafts, camping pads and birth tubs. We try to find and fix leaks before labor  - we are there to hold space, not whip out patch kits and kick you out of the tub so we can take over your birthing space with solvents and sandpaper. So, if you ever see a midwife clinging to the side of an inflated tub with a bucket of soapy water (leaks make bubbles) or a stethoscope, try not to laugh. She is just trying to locate a tiny leak.

If you didn’t know, soap is a great way to find a leak in something right before you decide to just throw it away.

If you didn’t know, soap is a great way to find a leak in something right before you decide to just throw it away.


Several years ago I had a run of birth tub problems. It seemed like they leaked air at Every. Single. Birth. I checked them in between births, patched what I could, suffered through slowly leaking tubs during labors and replaced tubs just to have the new ones leak. One tub failed spectacularly. This was baby number two for a lovely family in my neighborhood. Her first labor and birth had been pretty quick and straightforward, so we were surprised that her 2nd labor was harder, longer and more intense. After several hours she decided to get in to the tub. As she stepped in, I heard the familiar hiss of a patch not holding. I found the patch and attempted to re glue it, but the tub was losing air FAST. My client was only getting relief from the tub. So, I did what any reasonable person would do. I called a doula in the neighborhood and paid her to hold the patch on the pool for the duration of her labor. This meant snaking her arm in between the tub and the liner and leaning over the side, practically in the pool herself and applying not-insignificant amounts of pressure on the plastic patch. For 4 hours. Thanks doula!  (have I mentioned how much we love doulas?)

At other births we have had to refill tubs between every contraction.  The mom has her contraction, doing what all laboring people do (moaning, breathing, coping) and also what most don’t (sinking toward the floor).  Then, we turn on the air pump and up she goes, the sidewalls filling and raising her back to position, water sloshing out all the while. So yes, it is not unheard of for birth tubs to lose enough air so that some water sloshes over the side. You will be heartened to know, however, that never, not once, over hundreds of births, has a tub popped completely or lost air quickly enough for the water to flood out.  Has this ever happened to you? Let us know if it has!



Filling with water

When I was a student, 13 years ago, I arrived with my preceptor at a labor on a hot, swampy, July day.  The dad had already helpfully inflated the fishy pool (we used to use these fishy pools almost exclusively back in the old days) with air and as we arrived, he was starting to the run the water.  We busied ourselves with the usual tasks of setting up for a birth - unfolding chux (why? I don’t know), assembling birth supplies, listening to the baby’s heart rate. Eventually I went in to the bedroom to check on the birth tub. Y’all, I have a strong stomach.  Nothing makes me nauseous on sight except maggots and…. this tub. The tub appeared to be full of egg drop soup, which is not something you want or expect, birth tub wise.

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Actual picture of the birth tub

plus onions



The water was yellow and cloudy with long, thin, gelatinous strands of egg-white looking goop throughout. If you’ve ever wondered why I am so adamant about using a NEW hose for filling the birth tub, this is why. In this instance, they had used a very, very long hose that had been sitting in the heat, full of water.  What grew in it was like the SCOBYs (symbiotic culture of yeast and bacteria) you find in your kombucha bottle. Interesting, but not something you want to have a baby in. We sent the dad to the hardware store for a new hose, drained the tub, sanitized it and filled it again.

Sometimes there is not enough hot water to get an entire birth tub full of water warm enough for a birth.  This was always true in apartments in the city, so we started pots and tea kettles boiling when we began filling the tub. A little known fact about me is that while I am patient when it comes to big things - labor, long drives, listening to my kids talk about space, I am REALLY impatient with little things.  Like, it’s extremely annoying how long it takes to pour all the water out of a tea kettle! It takes forever! It is so boring! So, at a birth one chilly April morning, I decided to pour the water out the top of the tea kettle instead of the spout. And this happened.

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I know

It was gross


The birth was imminent, so I gloved up and finished my work, swallowing a handful of ibuprofen when I had the chance. All I remember about the rest of that day is red hot searing pain and an internal dialogue that went something like “you IDIOT!”



Draining the Water

Cats and kittens, this is where we have the real fun. A hundred gallons of bloody, sometimes poopy water. What could go wrong?


Back in the old days - the aughts -  we used to drain birth tubs via gravity siphon. I actually have no idea why we did this because sump pumps are not a new invention.

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not like this!


Nevertheless, this was the apprentice’s task and it went like this:  hook the hose up to an outdoor spigot and run water until it reaches the pool which, ideally, is quite a distance above the spigot. One you hear your helper shout “OKAY, ITS RUNNING” (very relaxing for the new parents, obviously) you rapidly turn off the water, unscrew the hose, and if all goes well, and gravity being a pretty solid theory, it usually did, the water will start to flow out in to the yard. The water runs slowly and it takes a very long time to drain a tub. But it will drain.  Even on a good day this was a ridiculous procedure, often cold, always wet, involving tromping through bushes and mud. A bad day involved poison ivy, rain or snow.

After one cozy winter birth, the kind where you arrive to christmas lights twinkling in the snow and leave as the sun peeks over the horizon, the neighbors got a siphon-related surprise. After tucking in mom and baby, after packing everything up, after pulling the hose back in through the window and winding it up in the bathroom, I got in my car and pulled down the long driveway. Only then did I notice the snow. I had drained the bloody tub on to a hill of snow.  A hill that now appeared to be the site of a massacre or mauling. Sorry neighbors!

 

There are a lot of bloody snow pictures out there….. here is one

There are a lot of bloody snow pictures out there….. here is one

Now, of course, we use sump pumps and with the aid of electricity we pump the dirty water straight in the bottom of the toilet. The sump pumps are powerful and drain the water fast. This is very effective, and also very fun for small people who enjoy hoses and water and don’t know about germs.  As a bloody pool was draining in to the toilet one morning, a wee toddler friend pulled it out and sprayed bloody water all over the bathroom. She did this for several minutes before anyone noticed. Another horror movie scene. We lock doors and supervise now, when there are curious toddlers around.

And here we are at, hopefully, the biggest birth tub bungle of my career (shared with permission). This was another birth in my neighborhood, a lovely first time mom on the second floor of a two family city building.

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Classic STL 2 family

Picture the birth on the 2nd floor there




She labored beautifully, and had her baby in the tub quickly and easily. In fact we had not finished filling it when she had the baby so the end of the hose was still in the tub, and we left it there, busy with other tasks, and maybe a little tired. Since the mom was small, we hadn’t used as much water as usual - it was a pretty concentrated mess as far as birth tub water goes. Baby poop, lots of blood. But normal stuff.

We got her and her sweet baby girl to bed and did the tasks of immediate postpartum: watching, waiting, cleaning. The hose had been screwed in to the kitchen sink faucet and I unscrewed it in order to wash my hands. You probably know where this is going and I am sorry to say you are right. Remember the siphon and the laws of physics?

At some point, the end of the hose was knocked out of the sink and on to the kitchen floor where it proceeded to drain the tub. By the time I made it back in to the kitchen there was two inches of bloody, poopy water on the floor.

This seemed bad. My apprentice and I frantically sopped and mopped, pushing water in to buckets with a broom and dumping it in the bath tub. The water has seeped in to the floor boards and under appliances. It was an endless, multiplying mess the way blood can be. Everywhere. We somehow got it cleaned up, disinfected the floor, and finished our midwifery work and went home. I went home thinking, well, that was bad but, LESSON LEARNED, to always take the hose out of the tub. That night I packed a roll of duct tape in the birth bag, vowing to also always tape the hose to the sink.

Several days later the landlord of the building called me. In the only stroke of luck in this story, he was the client’s father in law.  So it was with sadness and not anger that he told me what had happened.

I googled “bloodbath” so you don’t have to.

I googled “bloodbath” so you don’t have to.


The people who lived downstairs had been on vacation during the birth.

When they came home, they were surprised to find their kitchen ceiling red, brown and crumbling wetly. They were also surprised to find all of their many things in the kitchen, soaked in, and in the cases of dishes and pans, containing, old bloody birth water.  The landlord told me that, not only was the ceiling ruined, but that the people were “sort of hoarders”. They had dozens and dozens of kitchen items that were now, according to any reasonable person, ruined. Also, they were so traumatized, they decided to move.  

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No, it really does not get much worse than this.

I did pay for their items. But, after a small investment in bleach, I also kept some of those items.

So, if you ever come to my house for cookies, know that they were made with love…. and a kitchenaid mixer that was once covered in bloody birth water.

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The end.












Top 6 Reasons to Have a Doula at your Home Birth or Birth Center Birth

Should you hire a doula if you are planning a home birth or a birth center birth? People often ask us this. When I first began working as a midwife, I wasn’t sure what I thought. Isn’t is too many people? So much fiddling and maybe too much chit-chat for my stoic, quiet, midwestern clients? Too much fuss?

(The pictures below were sent to us by doulas with their permission and the family’s permission. We would love to include more pictures of all of you lovelies with links to your website! You can email them to rivercitybirthcenter@gmail.com please include a link to your website or page)

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Doulas have always been at home births

In pretty much every historical or ancient image of birth I could find, from ancient India to medieval Europe, there is a midwife and some other women being helpful.


Well, sometimes I am slow to catch on. The more births I attend as a midwife, the more obvious it is that birth doulas are a wonderful and truly unique member of a birthing team. I love them. My favorite people are doulas! In fact, when a first time mom tells me that she has hired a doula we know and like, I have been known to chart it with one too many exclamation point.  “Client has hired Doula extraordinaire Diane!!!!” So, without further ado:

Top 6 Reasons to Have a Doula at your Home Birth or Birth Center Birth

1) They are there before we are

When I had my first baby long, long ago in 2005, my midwife almost missed it. Because she lived a million miles away in another state, my quick active labor was too much for the laws of space and time. So, I spent most of hard labor in the bathroom alone while my husband dealt with the tub. Not super fun. Then, moments after I got in the tub, just as I was feeling pressure, my midwife called. She was lost (kiddies, this was life before GPS navigation). Since my husband is challenged in this area, it fell to me, in the throes of transition, to give the midwife directions. Seriously.

Lets think. Now how could all of this - being alone, being unsure of when to call the midwife to come, filling the tub, giving directions, calming a nervous partner - been avoided?  Dear reader, you are a quicker study than me: A DOULA!

Doulas usually come to you earlier in labor than the midwife. Monitoring baby and mother is usually not medically necessary early in labor, but you might still want support.  Support can mean many things, and in early labor a doula fits right in. She can: offer suggestions, perspective and privacy. She can help with timing contractions, position changes, and help with distractions and encourage sleep.  She is an early labor angel, stepping in and out when needed. She can help you figure out when to go to the birth center or when to call the midwives to come to you.

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A doula can…

help you rest in early labor so you have energy for active labor later. Pictured here, doula Elise Benoit now with MyBirth.


2) They have only one main job: to make you comfortable  

Its true. That is the doula’s main, maybe only, job especially at home or in the birth center. This can take many forms but from your perspective in labor, this is an extremely important job.

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Hip Squeezes!

Almost always amazingly helpful doula magic. This is Sarah Hendricks.

It can mean bringing you water, rubbing your back, adjusting pillows, lights and music.  It can be breathing with you or walking with you or walking the dog who is whining and annoying you. It can be helping your partner help you - adjusting their hands on your back or nodding toward the cup of water to remind them to offer you a sip. Other people on your team can do these things too, but they have other jobs as well. Your partner’s job is to love you. Your midwife’s primary job is to keep you and your baby safe. But your doula, she’s got your back, literally.  

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Your doula

always has your back (and shoulders, hips, forehead). This is Heidi with Heart of Virginia Doula services.

 

3) They provide continuous support

As midwives, our primary responsibility is the safety and well-being of the laboring person and their baby. It is super important that we are reasonably well-rested as birth gets close and in the hour or two after birth. So we sleep. We also have to chart, eat and discuss things with other providers, just like at the hospital. We can be there a lot, but we can’t usually be with you throughout the entirety of a long labor.  But YOUR DOULA CAN! (she needs rest too, so sometimes we trade out supporting you, but it is her presence that makes that continuous support possible).

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a doula’s presence

makes continuous support possible. This is Emily Bruno with MyBirth.

Doulas can also provide continuity in pregnancy!  You want to change course at the end of your pregnancy? Go for it. A recent client hired us very late in the game so there wasn’t a lot of time for us to all get to know her well or to build intimacy - how delightful, then, when her doula arrived at her birth with that deep, strong, wise connection in her doula bag, ready to go. What a difference she made in this woman’s labor!  A doula can give you the confidence to switch providers, knowing that part of your team will still be with you.

4) Cultural competence

This might be number 1 for some folks and is number one on our List Of Reasons We Don’t Have Staff Doulas. Fact: there are way more doulas in our community than there are out-of-hospital midwives. This means that if you have specific, important cultural needs, you might not have a lot to choose from, midwife-wise. But you probably have tons of amazing doula options.

Thinking back, again, to my first birth… my midwife was an older, conservative, rural woman.  In many ways we didn’t speak the same language and miscommunication was common - she managed to offend me and I am sure we confused her. A doula from my own community could have been a helpful cultural bridge on my birth team. 

For example, if you are a woman of color, you might want the support of another WOC.  In fact, this can be a critical piece of you and your baby’s health and well-being. Richmond is home to so many amazing doulas of color. You can find some of them here and here and here and here.  

Families might have other cultural considerations. Maybe they would like support from someone in a specific faith community or from someone who shares a first language. Expectant families might want a doula who is queer, or trans or who has extra training or experience in issues relating to LGBTQ pregnancy and birth.

We really want all of our clients’ needs to be met - including cultural and spiritual needs. Who can help with that? A DOULA!


5) Helping people are helpful!

Out-of-hospital birth includes a lot of moving parts.  There can be pets, phones, laundry, kids, chickens, photos, videos, mail, cooking, driving - did I mention kids?  Do you need someone to make sure the chickens get cooped up at night? Or someone to help with a nervous older sister or stoke a fire on a cold day?  Ask your doula!

Also? Doulas are helpful for the midwives.  While we never want to take away from the support they provide you, we have been known to ask a doula to grab a towel or turn off a fan.  An extra set of calm, skilled hands is always welcome.

Many doulas take pictures and videos.  They might not be as skilled as some pros (also awesome additions to your team) but they can take over camera duty when your partner needs to focus on you.  

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doulas can take photos

during and right after the birth, so you and your partner can focus on baby

6) More postpartum support

I’m going to tell you something else about my first birth back in the mid-aughts.  I ended up with A Bad Baby. And no support.

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Young Linsey

exhausted, trying to figure it all out alone

I was blessed with one of those babies that did not sleep or nurse. He screamed. I’m grateful I was young because I somehow found the energy to figure out baby wearing (the ONLY thing my child liked), breastfeeding and most importantly, I was able to find support.

But it all would have been immeasurably easier with more knowledgable, experienced, professional support.  At RCM we check in on you a lot but to be honest, you really can’t have too much postpartum support.  A doula will visit you postpartum at least once and help you process your experience. She will have referrals, tricks and ideas to help you during those first few unbelievable weeks.

Which leads us quite naturally to a post for another day…. The amazing wonderfulness of postpartum doulas, lactation support and night nurses.  

In the meantime, check out some of Richmond’s favorite birth doulas. There are so many doulas in RVA, and there are over 50 represented in the collectives below! At River City Midwifery, we offer clients a discount when they hire a doula. Some doulas may offer you a discount if you are planning an out of hospital birth. Doulas and midwives want to work with you to make sure you have the very best birth team, for you. … happy clicking and HAPPY DOULA WEEK!

Birth In Color

My birth

Village Birth

Richmond Doulas








Birth Tub Odyssey

I considered writing this blog post in the form of an Epic Poem. This story has most of the classic Epic elements: A Hero (in this case Heroines) of Legendary Proportions, Adventures of Super Human Strength and Valor (hours staring at incredibly similar items online, hauling massive tubs up and down stairs), a vast setting (China to Richmond and back!), and multiple sites of action (whats up, Ferguson!).  But, alas, this tale does not involve supernatural forces and I’m not sure this poet can remain objective and omniscient, so this is just going to be a regular blog post.

Have you ever noticed, tooling around online, looking at birth centers, that an awful lot of them have the sort of garden tub your mom might have had in her bathroom in 1994?  

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Often built in to corners, sometimes with outdated tiling, occasionally involving steps, birth center tubs seemed to us to be a design problem in otherwise beautiful birthing spaces.  Every so often you see a freestanding tub, usually appearing, in our browsing, to be way too narrow. These birth center built-ins and narrow tubes are nothing at all like the deep, wide, poofy blow-up birth tubs most homebirth midwives are used to.  

Our favorite birth tub, the LA Basseine, is a dream of cozy, sturdy functionality.

Our favorite birth tub, the LA Basseine, is a dream of cozy, sturdy functionality.

When we set out on this Grand Birth Center Adventure, we naively and offensively assumed these tubs were a failure in taste among our midwife sisters.  Perhaps birth center midwives and designers had just not gotten the memo about Beautiful, Round Freestanding Tubs. Perhaps they had forgotten how nice it is during home water births that to be able to reach a client from all sides of the tub. Maybe they’d never watched HGTV?

The truth is that we had heard whispered tales about birth tub woes before. Through the grapevine we heard about a hospital labor-tub program where all of the expensive tubs were returned not once, but TWICE.  We heard from students who spent hours cleaning jetted tubs after messy water births because, their preceptors told them, they literally had no other tub options. We remembered hearing that tubs were delivered with jets when none were asked for and that plumbing was always, always an issue.  Another midwife had mentioned ominously, in passing, “good luck finding a freestanding tub, we tried”.


So we were smug then, when a quick search in google, lead us to Wayfair. On Wayfair, there seemed to be a plethora of tubs that appeared perfect for water birth. They looked fine, were strangely affordable, and about the right height and size. We wondered, “have midwives never been to Wayfair before?”  We felt worldly and wise, and in the middle of about 49 other renovations, a lake of paint, and the business of starting a new health care business, we didn’t look too carefully at the specs (actually we didn’t know there were specs) and clicked “proceed to checkout”.

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Our new tub began its journey to us from China.  


An Epic Adventure

some of the perils on the journey

some of the perils on the journey

While we waited, we added plumbing to a bedroom where no plumbing was before.  To be clear, the amazing and patient Matt at New Day Mechanical installed the plumbing.  He worked like a surgeon performing reverse laparoscopic surgery. One small incision in the wall here, another two there, and one to let out the gas over there (there was no actual gas involved). Look inside, thread the plumbing in and voila!  

Our ceiling, to this day

Our ceiling, to this day


The Tub arrived. Adrianna and Marinda muscled and rolled it up the stairs, all by themselves!  I was not there, but I imagine they felt very pleased with themselves (and possibly annoyed with me) as they set it in to place.  But…….it was not right. Bafflingly shallow. We texted each other pictures of ourselves in various labor positions and declared that “it had to work”.

The most common labor position in water tubs

The most common labor position in water tubs

At some point, most people do this too

At some point, most people do this too

Then we went back to painting a second or third coat on some trim. We had it plumbed in, and it looked beautiful. I posted a picture of the tub (in black and white because the walls were still the color of baby amoxicillin) on Instagram and it was a VERY popular post (for us, I don’t really understand IG). Okay, we thought, the tub is good.  It has to work.

A moment in the spotlight, Instagram Fame

A moment in the spotlight, Instagram Fame


Paint trim, rip out flooring, imagine that all future clients will be 4’11”.  

That night, I took a bath in it.

You guys. It was AWFUL, and I wasn’t even remotely in labor.  Hard, slippery, so, so shallow. The combination of shallowness and largeness made it feel like I was just sitting naked on the floor in a vast puddle, which, well, I was.  The hard and narrow sides hit a strange part of my back and leaning over the edge in hands and knees - the most common water labor position - was a comedy of errors and bruising.  


Another time, my toddler had a great bath in it.  He declared it a “Great BIG BIG pool-bath!”. So there you have it. Thumbs-up from the under 3 set.

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It was with great sadness that the three of us convened the next morning and admitted to ourselves and each other that it had to go.  We had thirty days to return it.

And thus began The Great Tub Search.  We wanted a tub that was:

  1. Freestanding

  2. Water depth of at least 19 inches

  3. Circular or at least roundish

  4. Interior width of at least 36 inches

  5. Can fit in the building

This seemed like a reasonable list.  We learned more about bathtubs than we ever imagined was possible to know.  We learned that the Standard Depth of a tub in the USA is 14-17 inches. This, of course, is too shallow for anyone who is not a baby.  We learned that a “European depth” is 18 inches and that “Japanese or Greek depth” was 22 or more inches. We studied websites and we learned the listed measurements were often wrong.  So, we downloaded and studied the specs.

Now, we understand that people not concerned about humans emerging from bodies might not have the same sense of urgency over these few inches, but it was frustrating how difficult it was to determine “how deep is the tub”.  


You guys, there are thousands of freestanding tubs on the market. Who knew? They are mostly variations on the theme of “Banana Split Boat”.

Exactly like this

Exactly like this


Or sometimes they are shaped like shoes or horse troughs. We kept searching.  

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Japanese soaking tubs, we learned, were deep and round, but far too narrow for baby having. Like big buckets. We learned that those Friends-era built in garden tubs, usually jetted, offered the best depth, but we couldn’t and didn’t want to tile a tub in to the simple little 1930s bedroom that we loved. And NO JETS EWWW.  So we looked, and looked.

Late at night, loopy, I even tossed hilarious hospital birth tubs like this in to the ring.

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Some of them are actually pretty cool, but mostly not available in the US (of course) or hospital-budget friendly not low-debt birth center budget friendly.

I mean, this could be cool.

I mean, this could be cool.


And, no post about waterbirth tubs would be complete without this:

I’ve always wanted to be a spaceship pilot!

I’ve always wanted to be a spaceship pilot!

or this

Someone actually made this.

Someone actually made this.

At this point, we considered scratching the whole birth center idea and opening a birth tub manufacturing company instead…

At this point, we considered scratching the whole birth center idea and opening a birth tub manufacturing company instead…

We did find one tub that was kind of perfect.  I present to you: The Aquatica Pamela.

Yes,  Aquatica , this tub is perfect for our next birth suite! Construction starts soon!  hint, hint

Yes, Aquatica, this tub is perfect for our next birth suite! Construction starts soon! hint, hint

She wasn’t the prettiest tub at the prom, but she fit every single criteria. Except one. She wouldn’t fit in the birth center, up the stairs or in the room.  We contemplated removing doors, windows, trim, hiring a crane, and/or changing the entire layout of the birth center. She was also way out of budget. So we got special tub financing.

However, before clicking “buy now”, this time, like a pack of geniuses who learn from their mistakes, we made a template from an old sheet and laid it in the room.  No. No way. Way too big. Would be like a cereal bowl in a dollhouse.


We vowed to get Pamela for our next birth suite, because in all other ways, she is kind of perfect. At least we won’t have to go through this again in a few months.  

Finally, in an act of desperation we did what countless people before 2017 have done.  We went to a store.

These still exist!

These still exist!


Now, I had been to another Ferguson the previous week and found a tub that would more or less work, but it wasn’t perfect.  Let’s call this tub “Barnabus”. Here, my husband and child demonstrate “how to make showroom workers uncomfortable”.

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At the time, convinced there was a perfect option, we dismissed Barnabus out of hand.

Back at Ferguson, this time, we scoured not just the internet but the dark web of shopping: industry catalogs.  We learned about the world of Very Expensive Tubs which included copper (the metal) and Solid Surface (the rock) and other rare elements.  We added “must not weigh more than 300 pounds” to our list. Armed with The List and a mountain of catalogs, Marinda and our wonderful sales worker Teresa McClellan, found us a short list of acceptable, or nearly acceptable, candidates.  With names like “Olivia”, “Elise” and “Adriann”, they were fancy versions of the banana split boat. Mostly they were too narrow, too heavy, and had a several week wait time. And were over five thousand dollars.  


Back to the Aquatica Pamela?  We did some more measuring and contemplated our life choices. Maybe we could make it work. MAYBE IF WE GAVE UP AND STARTED FROM SCRATCH.  Did we all cry? I’m not saying.


Enter, stage left. Barnabus. In a sea of almost-right Olivias and Pamelas, we had looked right past the almost-right Barnabus. There he was on my photo roll, comfortably accommodating a giant adult human and a small 10yo. His edges were wide enough to lean over, he was deep enough. He looked alright.

See, looks almost right!

See, looks almost right!


We ordered him.


When he arrived from across town, we visited him at the Fergeson showroom.  He was good. A little underwhelming among all the shiny copper pennies and cold, hard rocks, but we took him home. (I mean, some strong workers brought him to the birth center).  

And here he is!  

He fits in very nicely, we think, even without IG filters

He fits in very nicely, we think, even without IG filters




I have to say, he looks great!  So deep and cozy, lovely, freestanding.  We can get to all sides, he fit in the door.  

Toddler contemplates life as a tub model

Toddler contemplates life as a tub model

Now, we just have to get Matt here to move the drain over three inches….

Stay tuned for reports on Barnabas in action!

(but seriously, we think this will be a wonderful place to labor and have a baby. It is deep and wider than it seems. One end is sloped for comfortable learning back or side-lying, and the other is straight, making hands and knees easier. The bottom is textured and not slippery and the sides are wide and easy to drape over without armpit bruises. We especially love how deep it is, so everyone, even tall people, can give birth in any position that makes sense for them.)