During a home birth, your midwife monitors you through labor at home, checks vital signs and fetal heart tones every 15-30 minutes during active labor, supports you through pushing and delivery, delivers the placenta, monitors you for 2-4 hours postpartum, then returns for follow-up visits. Most midwives arrive when you're in active labor (around 4-6 cm dilated) and stay through the immediate postpartum period.
If you're considering a home birth, you probably want to know exactly what happens when labor starts, when your midwife arrives, what she does while you're laboring, and how the actual birth unfolds. This article walks through the timeline and specific tasks your midwife performs, from early labor phone calls through the first few hours after your baby is born.
Most midwives ask you to call when contractions feel strong and regular, typically 5-7 minutes apart for an hour or longer. You'll describe the pattern, intensity, and any other signs like your water breaking or bloody show. She'll decide whether to come based on this information and how far you live from her.
For a first baby, midwives usually arrive when you're in active labor, around 4-6 cm dilated. This typically means contractions are 3-5 minutes apart, last 60 seconds, and require your full attention. For second or subsequent babies, she may come earlier since labor often progresses faster.
Some midwives arrive and leave multiple times if you have a long early labor. Others stay once they arrive. Your prenatal visits should cover her specific protocol and what criteria she uses to decide when to come.
Your midwife will listen to your baby's heart rate with a handheld Doppler or fetoscope, checking the baseline rate and how it responds to contractions. Normal fetal heart rate is 110-160 beats per minute. She'll also check your blood pressure, pulse, and temperature.
She'll likely do a cervical exam to confirm you're in active labor, though you can decline this. She'll assess the intensity and frequency of contractions by feeling your abdomen during a contraction or timing them herself. Then she'll set up her supplies in a designated area, often a bedroom or bathroom near where you plan to give birth.
Most midwives bring an assistant or second midwife, especially for the pushing and delivery phase. The assistant typically arrives later in labor, often when you're 7-8 cm dilated or feeling pushy.
Your midwife checks fetal heart tones every 30 minutes during active labor and every 15 minutes during transition (8-10 cm). She listens for a full minute right after a contraction ends. This intermittent monitoring is the standard of care for low-risk births and matches what you'd receive with a midwife in a hospital.
She'll check your blood pressure and pulse every 1-2 hours, more often if anything concerns her. She'll also assess your emotional state, how you're coping, and whether you're drinking fluids and urinating regularly. A full bladder can slow labor, so she'll remind you to pee every hour or two.
Most midwives keep detailed written records during labor, documenting each check and observation. These notes become part of your permanent birth record.
Between monitoring checks, your midwife stays nearby but often in another room unless you want her present. She'll suggest position changes, offer hip squeezes or counterpressure if you have back labor, and remind you to drink and eat light foods. She's there if you want hands-on support, but many midwives default to giving you space with your partner or support person.
If labor slows or stalls, she might suggest walking, nipple stimulation, position changes, or getting in the shower or tub. She'll discuss options with you rather than directing you. If she sees concerning signs like meconium in your water, a persistent abnormal fetal heart rate, or your blood pressure rising, she'll tell you directly and explain what it means for continuing at home.
Midwives typically don't do cervical exams every few hours like hospital staff often do. Many check once when they arrive, possibly once in late labor if you ask or if they need to assess progress, and then not again unless something indicates a need.
When you feel the urge to push, your midwife checks fetal heart tones every 5-15 minutes, or after every few pushes. She doesn't usually tell you when or how to push. Instead, she lets you follow your body's signals and push in whatever position feels right, whether that's hands and knees, side-lying, squatting, or in a birth pool.
As your baby crowns, your midwife watches the perineum and may suggest slowing down or breathing through a contraction instead of pushing to let tissues stretch gradually. She might apply a warm compress or use her hands to support your perineum, or she might not touch you at all. She won't do an episiotomy (surgical cut), which midwives perform in less than 2% of home births.
Once your baby's head emerges, she'll check for a nuchal cord (cord around the neck) and either slip it over the head or have you birth through it. After the shoulders deliver, she'll likely guide your hands to catch your own baby or hand the baby directly to you. She'll place the baby on your chest immediately, dry them off with towels, and cover you both with blankets.
Your midwife monitors your baby's transition while they're on your chest. She's watching for breathing, color, tone, and activity. She'll assess these at one minute and five minutes after birth (Apgar scores) but usually doesn't announce numbers or interrupt your first moments together unless something needs attention.
The umbilical cord typically stops pulsing within 3-10 minutes. Your midwife waits for pulsing to stop before clamping and cutting, unless you've discussed a specific preference. Your partner or support person can cut the cord. You'll then deliver the placenta, usually within 10-30 minutes after the baby. Your midwife may ask you to push gently or may apply gentle traction on the cord.
After the placenta delivers, your midwife checks it carefully to confirm it's complete and examines you for tears. Small first or second degree tears often don't require stitches. If you want stitches or have a tear that needs repair, she'll suture you at home using local anesthetic. She'll also massage your uterus to make sure it's firm and check your bleeding.
Your midwife performs a full newborn exam, typically within the first two hours. She checks heart rate, respiratory rate, temperature, and examines the baby's body systems. She'll measure weight, length, and head circumference. Most home birth babies weigh between 6 and 9 pounds at birth.
She'll offer antibiotic eye ointment (required by law in most states, though you can decline) and a vitamin K injection to prevent bleeding disorders. Vitamin K can be given as an oral dose instead, though this requires multiple doses over several weeks and isn't as effective. She'll also do a heel stick for the state newborn screening, usually at a visit within the first few days.
Your midwife will watch the baby nurse or attempt to nurse. She's checking that the baby latches, that you're comfortable, and that the baby's sucking reflex works normally. This first feeding usually happens within the first hour or two after birth.
Most midwives stay 2-4 hours after delivery. Before leaving, she'll confirm your bleeding is normal, your uterus is firm, your vital signs are stable, and the baby is nursing or has attempted to nurse. She'll also make sure you've urinated and help you to the bathroom if needed.
She and her assistant clean up blood and fluids, bag all used supplies, start laundry if you want, and bring you food and drinks. They'll change your bedding and help you get settled. Your space should look relatively normal when they leave, not like a medical procedure happened there.
Your midwife typically returns within 24 hours for the first postpartum check, then again at 3 days, 1 week, 2 weeks, and 6 weeks. These visits happen in your home. She checks your bleeding, uterus, any tears or stitches, and how feeding is going. She also weighs the baby and continues the newborn assessments.
During your prenatal appointments, ask your specific midwife about her protocols: when exactly she arrives, how often she checks you and the baby, whether she brings an assistant, and what her postpartum monitoring schedule looks like. These details vary between practices. Also ask what she does if labor stalls, if she finds meconium, or if the baby needs help transitioning. You want to know her decision-making process and at what point she'd recommend transfer.