One of the reasons first-time mom Sabina Hillesheim chose midwifery care was because of the home visits midwives provide to clients after the baby is born. “I developed high blood pressure at the end of my pregnancy and also had some complications during labour and birth. My midwives responded to my particular needs, including extra visits at home,” says Hillesheim.
Hillesheim’s daughter, Elise, was a little small at birth and Hillesheim’s blood pressure remained slightly elevated even after the delivery. Having a primary care provider check in on a daily basis to monitor both mom and baby’s progress was very reassuring, she says. “Because my midwife came over every other day or so, any questions I had were answered very quickly,” she says.
Sarah Leslie, a midwife with the Midwives’ Clinic of East York-Don Mills and Hillesheim’s midwife, says the ability to keep a close eye on clients who may be having issues or difficulties is one of the many benefits home visits provide. Readmission rates for newborns are lower among midwifery clients compared with the overall readmission rates. “That close care (via home visits) means they are being watched carefully,” Leslie says. By contrast, patients who have to leave their homes for postpartum care may intend to go to follow-up appointments, but may put it off a few days if they are having a difficult recovery, delaying when a health-care provider is able to check in on the baby’s progress.
Midwives perform standard follow-up with mothers during postpartum home visits, regardless of whether they delivered in home or hospital, checking things such as blood pressure, the mother’s recovery, as well as ensuring the baby is thriving and breastfeeding well. “Routine follow-up can happen in a clinic or at home,” Leslie says, “but it’s wonderful when it can happen at home because mom and baby aren’t exposed to the elements – either the weather or people who are sick in clinic waiting rooms.”
Though each practice differs a bit with regard to the number or timing of home visits, Leslie says an example of the basic number of visits provided to clients without complications is about four: the first visit is within the first 24 hours that the client is at home followed by a phone call on the second day. A second visit typically occurs on the third day and then the last visit somewhere between day five and seven. After that, midwives continue to provide primary care for both mother and baby up to six weeks postpartum through clinic appointments.
Midwives also typically perform one visit to a client’s home before the baby is born, particularly with first-time clients, to familiarize themselves with the client’s environment and circumstances. For clients who are socially isolated or lacking in resources, Leslie says the prenatal visit becomes a wonderful opportunity to get a better picture of the client’s overall health and situation. Compared with visits in a formal clinic setting, “in their home, you are able to see a woman in her own environment. For those women who may be struggling, they feel more comfortable because we’ve taken the step to come to them,” she says. At regular visits, clients may not discuss that they lack the things they need for the baby, or that they may not have enough food for themselves to support breastfeeding. Once in their home, midwives can more easily identify these issues and provide clients with additional resources. “There’s no substitute to fully understanding a person’s whole experience,” Leslie says. “It’s integral to optimal care.”