Let's Talk Homebirth with Dr Robyn Thompson
A Live Interview with Dr Robyn Thompson, midwife with over 45+ years experience, 25 of those years as a Homebirth Midwife. Dr Robyn Thompson is also a breastfeeding expert and founder of the Thompson Method, with Chelsea Kerley.
Is it safe for a first time mum to have a homebirth?
Dr Robyn 00:38
Yes. In my experience I can talk about my experience, yes it is. I can't give you the figures offhand but, over 25 years I have been with hundreds and hundreds of women who chose to give birth to their babies at home. With the number of women being herded in, through and out of the hospital system and intervention rates increasing phenomenally and all the things that are done to women and their bodies, that is not done at home, a Homebirth with an experienced Midwife, practised safely is safe.
Dr Robyn 01:27
An experienced Homebirth Midwife carries a small kit with her, which is equivalent to a small labour ward kit that you would have in the room with you. We can put drips up if required, we can look after bleeding, we can speak with the paramedics, we can transfer to a hospital if required, except there are more and more restrictions being added, including which hospital you can go to all of that sort of thing.
Dr Robyn 02:24
But if you're practising, as a professional, as expected of the professional midwife, it should be easy but of course you know we can't always predict what will happen, what's going to happen. And so we need to be experienced and we need to be prepared for those sorts of things. So, what we carry with us is really important, how we go about our business is really important but gentle, and also in a time when you do need help, generally a Homebirth Midwife has a buddy midwife who's there with her. We look after each other as well. And, the women know that. Women choose who they want around them as well. We need to remember that we are entering their home that we are visitors in their home. We do not take over their home and everything about them in that home but we do the very best to achieve what is expected of the reasonable midwife.
We were very fortunate in the UK as we still have the Birthing Suites but one thing I know I've learnt from you is that actually it always depends on where you're based in the world, and the policies the laws that are based in that country. And you've taught us that every single birth is unique so irrelevant whether it's your first, second, third or eighth baby. Each will be unique in their own way anyway, would you agree?
Dr Robyn 04:00
Yes, and if you're practising responsibly and you're accountable for your actions, you're providing a duty of care which is expected and respecting that women know their rights. They know that they have the legal right to consent. Of course, in event of a hospital transfer, the senior medical personnel will make decisions in case of an urgent or emergency situation, but you know with a healthy mother and baby with an Apgar score of 7 or above, no intervention is needed at that stage unless it's absolutely necessary. But what often happens is they start off with one intervention, and then the cascading intervention starts. And that's clear in the in the latest research. There's recent research out that's telling us about the continuous fetal monitoring has increased the C-Section rate, there's a whole lot of factors where the biological function of the woman's body and her unique, instinctive knowledge is impeded by the use of all of these technical things.
Dr Robyn 05:11
And if women and midwives don't speak up, it's going to continue so we have to be strong, and in our role from my perspective is that, we are with and beside women. We do not stand over them, we do not dominate them. We move with them in their rhythm, not over them. We talk with them gently and quietly with them. We do not give orders and instructions. We are gentle. We are calm and we listen to the baby and we listen to the mother, and we do our job and fulfil it to the highest possible quality that we can.
Dr Robyn 05:54
And I can confirm, and I know this is a fact that all of our followers are the ones that have learned from you, and become wise, to feel more confident to be advocates for ourselves which is so important, not only in birthing and breastfeeding but in motherhood and being a woman, as well. I know that I am definitely more confident to say no when I need to, and it's super important.
Dr Robyn 07:39
Many women believe they can't be monitored at home so how am I safe if I can't be monitored electronically?
Dr Robyn 08:35
Well I've always carried a handheld doppler with me. And that little doppler can be turned down so it's not loud and the readout can be seen, so that you can see the range of the baby's heart rate, because it does range. It's not staying the same all of the time. And so as the baby progresses with the mother through the labour through hip pelvis negotiating moulding head the angles, and the different shapes that the little baby has to manoeuvre through, and therefore babies heart rates do change. It's how they recover, that's important to know so we're listening to those things with the mother's consent. And of course she wants to hear her baby's heart rate tube as long as we don't have it thumping loud, it's about being discreet and giving her the best opportunity for the quiet time, she needs in the space that she needs as well. And that's where home birthing can be a huge benefit.
I laboured for seven hours at home on my birthing born in a dark corner, which is something I always talk about. I felt less pain and I felt so much more in control and calm. As soon as I went to the hospital, which I was highly encouraged to do by professionals, family, friends, because it was my first baby, and I really regret that, although I was fortunate enough to have a birthing suite back in the water, unmedicated, unmonitored, so I did have control. But there was a huge dramatic change in how I felt. The moment I walked through those hospital doors, and they had all those beeping sounds and I could hear other women, and it's go clinical isn't it. I completely see that it's not the ideal place for women who forever have given birth quietly in a place.
Dr Robyn 10:38
You know we do have to be wise, we do have to be on the alert because you know things do indicate to us that there may be something that we need to deal with, and and depends, you know what that might be at any one point in time, how we deal with that. There's no absolute but we do deal with things at home and we can put an intravenous drip up, we can resuscitate a baby, we can work with the mother. Whatever her needs are, if she's bleeding, there are ways of dealing with that, to prepare for emergency situations that's something that women, lots of women have asked us.
What if there's an emergency, you're prepared as midwives right?
Dr Robyn 11:19
We are a very educated profession. We are proficient in our own right. We do not conform to medical control. We participate in complementary discussion and complementary work with our medical colleagues. I've worked with many of my medical colleagues over my career, absolutely delightful to be able to be in a partnership with a woman who does not feel left out at any stage. Sadly, I find that quite lacking in the women's stories. The stories that women are sharing with me now. There appears to be a real void in in what's happening with women, even more so in the institution now more than ever. So I think that women, they will know whether they want to be at home or whether they'd prefer the hospital. It depends how far you have to travel because you don't really want to have your baby on the road on the way, on the highway. Although that does happen because they close down birth centres and they close down, you know, the birthing places so that means that more and more women were having babies on the side of the road. But we don't really want women to do that. It's not the best situation unless it's by pure chance. A rapid delivery and rapid birth with the baby descending quickly. If you're not close to a hospitatl, sometimes it may be be better to stay at home and hopefully, someone can come but that's not always the way unless it's planned. So again, there's, there's a whole lot of factors around it that can change for each unique woman, what might be her plan, or something that she didn't expect.
Dr Robyn 13:17
And may I add that we do not deliver babies. Women give birth to their baby. It's her birth. The only time we assist a woman with a delivery is when it's necessary, but we don't deliver babies, we actually to give the glory back to the mother, it's hers.
So Robyn, what if I change my mind? I'm at home and birthing, but what if I change my mind and I don't I want to give birth at home anymore.
Dr Robyn 15:29
That's okay because if we're planning well with a woman, and we're listening to what she's saying, if she does change her mind, we have a backup system available and ready. For me in my day, that was very easy, very well respected, no hassles, no restrictions whatsoever. We were welcomed into the hospital and so once you got there, you're included you were not cut off which was brilliant because, you know I've been with a woman for however long, why would they want to cut me off? Again, the communication needs to be inclusive with the health professional complementary services. So I was very lucky to have that sort of thing available but I'm not sure that that's working as well now, and for a lot of factors, but I do believe that we need to rethink. We need to re establish what how we're thinking and what are the benefits for a woman. What are her benefits not our benefits.
A lot of women are scared, or petrified about not having medical professionals from a hospital around them and they're not educated on what they can do with their bodies. With the help of working alongside an experienced midwife or doula, hopefully they'll see this today, and feel more empowered in making informed choices.
Robyn, what about after birth care? Women want to know if it's the same? Does the midwife disappear as soon as they've given birth? What about after birth care for themselves?
Dr Robyn 22:05
After birth, often refers to the placenta. So if we talk about the placenta, about postpartum time. Generally I'm referring to the placenta birth, and possible vaccinations that they will have in other medical interventions, and of course the first breastfeed, and those few hours after that. So I work with women on the basis that it's how her birth has been, and how she feels. But, if possible, not to separate from her baby. That's probably one of my most important principles. The first three golden hours are a time where the mother and the baby have time together, providing the baby's Apgar score is seven or above. The baby is with the mother where it should be. The baby has just come from the mother's uterus, so it should be her right there. Not with someone else, unnecessarily. Routine procedures can wait. They are not urgent. They are for ticking boxes to say they have been done. So I think ticking boxes needs to be reconsidered and the respect given back to the woman that this is her time, not our time, and those sorts of things, can be done when appropriate and when the mother agrees.
As far as vaccinations go, are you talking about hep B and vitamin K?
Dr Robyn 23:44
I'm talking about both that's yes exactly what I was thinking.
Dr Robyn 23:49
Neither of these need to be administered immediately unless there's a known history that might need consideration in relation to the unique woman and baby. In Japan, they have a syrup for Vitamin K. They don't actually inject babies and I think we could do that here too. I'm not sure how we would go about it. We used to use the MPL and I would help the mother express some breast milk and mix it with that because the taste of the MPL in the baby's gut is not good. You know, it's, it's not the first thing the baby should have. It's the colostrum the baby should be having.
So that's why this education is really useful.
Dr Robyn 24:47
So the little babies should be with its mother locating the breast, in its own good time but many people expect the baby to do this within an hour. It depends on the unique baby, whether the mother's had opiates, those babies may be sleepy. It depends on the history, it depends on the story that's happened really. So you're going moment by moment, and then it's really important to not to rush. There's no need to rush. The mother needs time. The baby needs time for the instinctive skills, for the small brain to create the coordination that's necessary to make its way to the breast. And then they feed at their leisure, not rapidly not hurried not shoved out of the room and corridor in a chair. They have that piece of time. It's very, very important. The baby will feed frequently from both breasts. Under most circumstances. Not always. And draw down the colostrum, which prepares the newborn gut for the rest of its life. The microbes that are coming through that colostrum into that little baby's digestive system is phenomenal. So we need to always as much as possible, encourage, and make sure that we facilitate that.
What would you say the benefits are to home birth with breastfeeding? You talk about calm and patient and allowing the mother and baby to lead in their own journey but how does a home birth encourage that?
Dr Robyn 26:20
Well, a mother takes most times, depending on the circumstances, the mother takes her own baby. We don't actually take her baby. She holds her own baby she decides when she wants to separate the cord and the placenta. It depends on the circumstances entirely at the time. There's the preparation during pregnancy that's very important.
Dr Robyn 27:01
You want to observe the colour of the baby's lips. You see the baby pinking up once they take their first breath. Baby's born, particularly through water actually don't breathe straightaway. They're very calm, and they take that time that's required to take that first breath. And it's really beautiful to see that, and then some of the mothers who've had a baby before or several before say our baby's not crying now there is a difference. So the transition through the water seems to be beautiful. Again, it's not always perfect because you know I have had to help unravel a little baby who was rounding cord through the water and that worked beautifully, but again it's always in the moment.
So, it's really nice to hear that actually because Jacob never cried. And when I gave birth and I transitioned I birthed him and pulled him onto my chest, and he never cried and I the first thing I said to the midwife was "Is he okay?" and she said he's happy, he's fine. And then within 15 minutes he latched on, and that was before the nurse came in and told me I was doing it wrong, which was the downfall of our journey, but up until that point it was rather beautiful. So it's interesting to know they don't have to cry.
Dr Robyn 28:25
Mothers don't do anything wrong. It's the way we go about business that's wrong. Our professional role is not to make you feel like you're doing something wrong. We can make suggestions that might help. But I don't believe we have any right to say anything that makes you feel as though you're doing something wrong. We guide you gently, we advise you sometimes if we feel it's really important, but most of the time we make suggestions. And you know that's my way anyway. And I am thankful for the women that have given me the environments to be in that I could see this unfolding like you know the first Homebirth baby slept more than four hours.
Dr Robyn 29:23
And I just talk about hydration because if we look, if we know the baby's been hiccuping. Wherever you are having a baby, even on the side of the road, if you know your baby's been hiccuping, the baby hiccups each time it has a drink. So then it settles down and then it hiccups again. So what I'm looking at when I have that knowledge is the baby is well hydrated. So if the baby's well hydrated at birth, then, I'm observing carefully and quietly, but not taking the baby, not touching the baby, just observing and documenting what I say. And what I'm hearing and all that sort of thing but not interfering with that beautiful mother and her baby. You know, we're the only mammals except for the mammals in the zoo that, that allows anybody to takes our babies from the mother unnecessarily. We shouldn't be doing that. You see I'm passionate about that!
We have a question, Dr Robyn from Emily Baxter, a very good question and she says, "What about home birth after a C section?"
Dr Robyn 30:56
Well Emily that's a unique situation. It's a unique journey through your pregnancy. It's a unique journey into your, your baby settling into your pelvis, your beginning your early labour, into established labour. All of that is unique for you. If you've had a previous Caesarean section, because what's important there is that if there's any signs of scar rupture. There's no one answer. I have worked with many women who had a previous Caesarean section gave birth to their baby at home, and one was a 10 and a half pound baby and she did it beautifully. But I'm not saying everybody can do that. The mother prepares for it in pregnancy, preferably, that would be my suggestion. She prepares for it, she works towards it, and she keeps an open mind, and continues to keep an open mind, and we're keeping an open mind with her. Then the opportunities to do whatever she needs at any one point in time, are there, and that's really really important. You know, not to have everybody believe that they can do this, because not everybody is the same. And so we can't give you a 100% guarantee we cannot give you a 100% answer. But we do our very best to help you achieve what your goals are.
I hope you found that helpful Emily that;s very, very useful for me as well. So Robyn, we've got a couple of people asking about alternatives to pain relief, and managing pain at home.
Dr Robyn 32:49
Well, for me, most of the women I worked with had their own plan for their own pain relief and most of that time would be in the water, where they're buoyant. When they're buoyant that releases the tension of the muscles and the nerve endings and they can move more freely in the water because that's their own space.
That was one big thing, when the woman immerses in the water you can just see her facial expression changing. I have some beautiful photographs of that.
Dr Robyn 33:31
And we have a couple of our people here who have researched that and it's been researched right now in Europe, so it's it's clearly okay with where we use more taps, there are water injections over the area that's most painful for the woman, and then by just, you know, very very slightly under the skin, not deep, no needles deep, very slightly create a little bubble. And that relieves nerve ending pain because it's a bubble between the skin and the you know that very first early layer. And what it does is blocks, the pain way to the gateway to the brain. And of course everyone is educated. Midwives are educated to do that.
Perhaps we'll have to chat in the future Robyn about pain relief, and pain management options, so that we can go into more detail.
Dr Robyn 34:21
I've got to say that if you can avoid epidural then that protects your baby from the effects of the opioids. It also protects you from the effects of the opioids, but if you do need, you know anaesthetics for a valid reason or you do need surgery, of course you need those drugs to help you through that time. So it's not about one thing fixes all and there's people who have their own Tens machine, there's a whole range of things that can be done. All the things for each individual, unique woman and she feels best with what's right for her.
You mentioned having a plan, and being open with it, but trying to have an idea of what your wishes, are communicating those wishes, and including breastfeeding in that plan.
Dr Robyn 35:24
Yes, I have a template where women can take whatever they feel is important to them. I've included the warnings and the information in it for the women to be aware of. So it's very important that the template is not regarded as a birth plan for every mother, because that's not right. It's a template that explains a whole lot of things that helps the woman have the knowledge. She goes with the knowledge and she works on her own unique situation. And also she knows her rights so she can have discussions with people about things that she agrees with or things that she may not want right now or things that she doesn't agree with.
It's wonderful. I wish I had access to it when I was pregnant and I know so many women have reaped the benefits from having that guidance. It's really good stuff and if you'd like to know more about the template we can let you know as Robyn said it's a great template, with supporting videos by Dr. Robyn explaining how you can break it down and implement it and make it unique for yourself and your wishes and your situation.
I have another question here, Robyn, which is a quite an interesting one. Can I have a home birth at 42? It's my second pregnancy but the last was 11 years ago.
Dr Robyn 37:22
Kirsty, I don't know whether you're planning a home birth at 42 but I have been with with a mother at 45 and she did very well, beautifully so again I can't give you an answer, that would be for you as it depends on your circumstances and how you've progressed through your pregnancy. And you've already had a baby so you are knowledgeable. You have that you stored information which is very important. It doesn't mean to say, it'll be the same but it gives you more experience. That's the real thing, the experience that comes may not be the same. However, yes, by all means you can make your choices as you go along, it doesn't have to be rigid and I think that's the big problem. It's the fear that we generate by coercion and rigidity. It's about being flexible to see how things go for you.
That's so true and it seems to be a very controlled environment for women at the moment.
Dr Robyn 38:42
And there are some women who choose not to have a pool at home and that's okay, that's fine. I've had one woman who chose her spot on her beautiful bedroom floor with it all covered and doing what she needed to do. Another one on her back balcony. Another one in front of her fire in the winter. So, the warmth radiating from the fire was, of course, protected, but that's where they chose to be so you do not have to be in a pool if you don't want to be. You can, if you need to use water you can use the shower, you may not need to use anything you might be walking. Now it's different for everybody, and you know a little bit of hip movement is great because that helps the baby, negotiate through the pelvis. So, you know there is a doctor in America that actually dances with the women and I think that's magic because it keeps our bodies in the mobile situation, preferably not on a bed. Preferably off a bed because that flattens the sacrum and the sacrum can't rise and the diameter in the pelvis is reduced when you're laying flat on your back. And if someone does need to give birth, in a reclining position or a laid back position, it's called McRoberts Position and that can sometimes be very helpful but not with someone standing over you, directing you to push! No way. It's what you do in your good time.
Dr Robyn 42:04
So, McRoberts is a position where you either sit and draw your legs right up or you lean back and draw your legs right up. McRoberts is a good position and it's worked very well over the centuries. In my experience, an upright position works because you have gravity working with you and you have movement. Whatever is right for the woman.
Dr Robyn 42:41
A lot of women when they're really getting close will start to make a sound, then their knees will bend. They'll make another sound at the peak of a contraction, which gradually increases till they've gone to hands and knees on the floor. Many women will do that and that's the way it just happens for them. No rules.
Robyn would you say that homebirths and waterbirths reduce the risk of tearing?
Dr Robyn 43:17
The water I think that the water creates a buoyancy effect. Again, if you're being instructed in my experience is that for the women who were instructed to push, their perineal muscle is stretched beyond capacity too quick. So, if you can do it, gently in your own good time without someone instructing you, that's where we get into your rhythm, quietly be not loudly and not above you. We work with you very quietly to encourage you in your rhythm, and let that perineal muscle stretch, stretch, stretch. It stretches eight different ways so it's a very flexible muscle and I believe if I've got it right, correct me if I'm wrong, that it's the only muscle in the body that goes that many directions, so it's not meant to be forced open. It's not meant to be ripped by a hard pull with forceps because soft tissue tears, and we try to avoid tears, if we can. By working with the woman in the moment, as long as the mother and baby is safe.
Wow, I did not know that it was meant to stretch that way. It is incredible, the changes our body goes through and the adaptations it makes to birth to bring the child into the world is incredible stuff.
Robyn, would you share one of your own homebirth experiences?
Dr Robyn 45:39
Let me tell you my first birth experience.
I was invited to a Homebirth, with a midwife colleague and my dear friend, our GP was there too, who was available if ever we needed him. This mother had a beautiful birth at home. Her two little boys were out with their Nana and she was minding them, in the rest of the house. And this mother gave birth to this beautiful baby and I was very anxious because this is the first time I've been out of the hospital system, while a mother's giving birth, even though I felt, I can do those things with women or I can be beside women, but my midwife colleague was very relaxed, it was all happening beautifully the mother was giving birth to her baby and taking her baby. It seemed to me like this baby didn't breathe or wasn't going to breathe so I got the little sucker ready and anyway I could just see the eyes watching, saying it's all right. The minute, this little baby boy took his first breath, the dogs outside the bedroom window started howling. You have no idea and even now when I tell a story, I'm tingling, then the dogs in the neighbourhood joined in howling all around there were dogs howling along the street and around. And then her mum said that the cats on the front doorstep were were meow, as well. So the message went out. It was phenomenal. So that's what encouraged me to experience another home birth and another homebirth. Because I had so many encounters with people's animals, and the young children were brilliant. And just recently that mother contacted us because she's going to be a grandma now. I hadn't heard from her for life, you know, her kids have all grown up, they're all adults, which is lovely. I got such a surprise, but I have had contact now from a lot of either the children or the parents
I got goosebumps when you told that story that is such a touching story I'm so glad you shared that with the animals of the wild!
Dr Robyn 48:35
Chelsea there's plenty more there's the koala bears. There's the mayor, the mother's mayor, there's the Python snakes. It's the rabbits, there's the fruit lizard and there's the cats. (laughs) It's absolutely amazing. When you see how the interaction is when you've not been used to that before, it's not that they're there in the birth space. It's there around out there beyond the birth space. There are so many stories to tell, then that's not just all there are other stories too, but I do have now more of the babies that were born at home, I've had contact with. They've contacted me for different reasons or the parents or the mothers, you know it's really beautiful to look back on it and think, oh, goodness.
You were there with your grandson's birth at home. Is that right?
Dr Robyn 49:42
Yes I flew to Japan for the eldest one. And his Japanese grandma came over for the birth and his Japanese aunty. So, I was privileged, so privileged. And the Japanese Midwives Association made it so easy for me to be able to fulfil that journey with my family. They, actually didn't ask me to register. They checked me out, we had a long conversation, and then they wrote the story in their journal later. So, I was very very privileged.
But thank you for sharing that Robyn if you can hear me, and we've got lots more questions coming in and lots more experiences being shared, which is wonderful. I'm sure we'll all enjoy reading those for the rest of the day, keep them coming. Are you considering a home birth? Let us know. We hope you found this useful of course, Dr. Robyn does speak about this a lot more in depth in the club in the program. So Dr. Robyn, It's been an honour.
Dr Robyn 51:28
Can I just acknowledge some of my colleagues over the many years. We have been a unique group of midwives, I would say. Some obstetricians, and GPS, and I want to thank them because they know who they are. And, some amazing midwives that have travelled to the other side of the world to help women as well, who set up birth centres and done things as well so it's really something that we definitely need to consider and reconsider and rethink. We need to be able to provide women with what they want, not what we want them to do.
On behalf of all women worldwide thank you for being up all night and for fighting for these rights because throughout your career, Dr. Robyn, you have made, not just ripples you've made waves of difference. So, we're very grateful for that. And hopefully it's movement or change things it will continue to make change as you spread that education worldwide. I know I am definitely educated, and I will pass on education as will, the rest of our members and that's what it's about us because the community is strong.
Dr Robyn 52:48
Absolutely, and Birthing on Country is also very very important too. We do not let that go, whatever we do.
Yes, I know that's very close to your heart. Well, thank you so much for your time again Dr Robyn. <end>
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From all of us at The Thompson Method team, happy birthing & happy breastfeeding.
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