Last month (July 2025) I attended two more homebirths and I’m in awe. In awe of women’s inner knowing, inner power and instinct. These two births I have attended have been quite different but also similar in how women have birthed so in tune with their bodies. And if you have fears around birth, keep reading, you too can have an amazing birth.
 
The first homebirth was by my first ever client as an independent midwife, the first family that trusted me with their care when I was just starting out. I remember the excitement when on that first online consultation back in November they told me right there and then that they wanted me to be their midwife. Such an honour!
Fast forward 9 months and I attended the birth of their first son on my own as the second midwife didn’t make it. It was a beautiful short birth with only 20 minutes of powerful gutural pushing and a bit of running around on my side trying to get everything ready… So much so that, at the last minute, I realised that we didn’t have a mirror to see the perineum stretch as the baby comes and possibly for the first time in my career, as the lead midwife, I didn’t see a baby come out. It was actually pretty mind blowing and powerful. For the first time ever I was not looking at a perineum and saying “well done, you’re doing great, just breath through”. No, for the first time I was speaking to the mum directly and trusting that birth will go well. She was birthing very instinctively and she was reaching out to her perineum as she felt the baby crown. And without seeing, I knew. I knew that she was feeling the ring of fire as her pitch changed and then I encouraged her to breath through. But she couldn’t slow down the speed at which this baby was coming to the world, so pretty soon he was born in the pool without complications. She did sustain a second degree tear and, again, for the first time in my career I did not suture it for maternal request. And guess what? It healed beautifully.
 
 
Now, onto the second birth. This other first time mum also had a homebirth but she needed a bit more reassurance and it was a longer labour (very average length for a first time mum though!). There were some fears that she needed to overcome but, in spite of that, we witnessed a powerful woman that knew exactly how to move and how to breath her baby out. There were some cries for help (for a forceps, to get this baby out, for a hospital transfer-as women do when they go through transition) but still the body had such a strong inner knowing that this mum birthed her baby in a semi squatt position with her left leg up because the baby was coming with his arm on his face and the head was tilted as a result. Several times this mum felt like the baby was stuck but she had the freedom to move and suddenly without warning we saw head! We were quite surprised as she did not pushed once. She breathed the baby out and had an intact perineum. Yes mums! It is possible not to tear for your first baby, even when they come at a funny angle or with arms out like superman. And it is possible to still have a physiological birth with some fears. Birth and motherhood makes us face dark sides in us, it is part of the process.
 
These women were truly superwomen that birthed instinctivly and it goes to show that with trust, the right team around and the right environment, women can overcome their fears and have truly physiological births. To the point that even us midwives still get surprised by it.

Resources For Fetal Heart Monitoring

1.When did we start monitoring babies in labour?

For more high quality evidence around fetal monitoring please visit Kirsten website here, an obstetrician with a PHD in CTGs. https://birthsmalltalk.com/

In this post she discusses intermittent auscultation: https://birthsmalltalk.com/2023/08/23/what-is-intermittent-auscultation/

Hear her talk about the lack of evidence behind CTGs in this podcast: https://open.spotify.com/episode/1eXZY973Oxbs1ducavpSAk?si=872f8c4077be4ba5

Post on the history of fetal heart monitoring: https://birthsmalltalk.com/2023/08/09/listening-to-the-fetus-the-history-of-fetal-heart-rate-monitoring/

Cochrane review comparing CTG to intermittent ausculation (CTG increases interventions
): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006066.pub3/full

Does CTG use improve outcomes for high risk women? https://birthsmalltalk.com/2024/10/16/the-story-behind-our-paper/

2. How should we use intermittent auscultation in labour?

These are the NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

Midwife researcher and lecturer Rachel Reed has a brilliant article and podcast about this where she unpicks the evidence around the recommendations for intermittent auscultation protocols here https://www.rachelreed.website/blog/listening-to-baby-during-labour

and podcast here: https://open.spotify.com/episode/3sJeIR3xUOr20EBRGilHxl?si=818537594dd04457

The WHO recommendations for intrapartum care: https://iris.who.int/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1

3. How does intermittent auscultation detect fetal distress?

For more on normal and abnormal heart rate monitoring watch this explanatory video: https://www.youtube.com/watch?v=Ni48bbtiZgs

4. What happens if there are concerns with the fetal heart rate at a homebirth?

NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

5.What is better for fetal monitoring in labour: a Doppler or a Pinard/fetoscope?

To read about the research and the experiences of midwives using a fetoscope/pinard antenatally and in labour check these links out.

Short facebook comments compiled in this magazine here: https://www.midwiferytoday.com/mt-articles/wisdom-of-the-midwives-issue-131/

Midwives perceptions of fetoscope vrs Doppler Tanzania https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1736-y

Midwives experiences of Pinard use Norway https://www.sciencedirect.com/science/article/pii/S0266613822000407

Defense of fetoscope article by American midwives

https://hearthandhomemidwifery.com/blog/fetoscope-a-tool-of-the-midwifery-trade#:~:text=Fetoscope%20uses%20go%20beyond%20just,birthing%20person%20and%20the%20baby.

A Cochrane review that compares Doppler and Pinard use in low income countries: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008680.pub2/full

For a compilation of research that compares the use of Doppler to Pinard check this link: https://www.cochranelibrary.com/content?templateType=related&urlTitle=%2Fcentral%2Fdoi%2F10.1002%2Fcentral%2FCN-01110791&doi=10.1002%2Fcentral%2FCN-01110791&p_p_id=scolariscontentdisplay_WAR_scolariscontentdisplay&_scolariscontentdisplay_WAR_scolariscontentdisplay_action=related-content&p_p_lifecycle=0&p_p_mode=view&type=central&contentLanguage=

6. What if you decline some or all fetal auscultations?

Is fetal monitoring essential?: https://birthsmalltalk.com/2024/11/06/myth-busting-3-fetal-monitoring-is-essential/

7. What to bear in mind about intermittent auscultation in labour?

Examples of womens experiences of fetal auscultation in labour: https://www.sciencedirect.com/science/article/pii/S1871519224002658#bib14