“On purpose?” is the question usually accompanying the look of disbelief on the faces of people I talk to when I mention that three of my four children were born at home. For many, I think that the term “home birth” conjures up images of voodoo magic, funky-smelling incense, chanting, and a very big mess. This paper is my attempt to give a more accurate picture of what home birth is really like, and the midwives who help the families who choose this very valid birth option.
1: Is a planned home birth really a safe option?
I was so excited when a new study of over 500,000 births in the Netherlands was published in April of 2009 on this very topic! In the conclusion of the abstract, it says that “…planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.” (1)
Basically, this means that having your baby at home is just as safe as having your baby in a hospital, as long as a well-trained midwife or doctor are in attendance, and you can quickly get to a hospital if the need arises.
2: What are the costs, and will my insurance cover a home birth?
In Colorado, a home birth will usually run somewhere between $2000-3000, compared to approximately $10,000 and up for an uncomplicated, drug-free vaginal hospital birth. This price almost always covers all your prenatal care, labor and birth, as well as postpartum care.
Many insurance policies will cover at least a portion of this cost, depending on the type of coverage. Usually, you can expect 60%-80% of the costs to be covered, but you may have to submit a claim, as some midwives do not do billing. At the least, they will provide you with paperwork you can submit to your insurance. I have had at least one client, who was uninsured, and chose home birth just because of the cost savings to her family!
3: What if my baby or I have a health issue?
Home birth is not for every woman and baby. A midwife will screen you very carefully before taking you on as a client, going over medical history, and ruling out any known issues from the beginning, and referring you to obstetrical care if necessary. There are other issues that may come up with screening tests later on in your pregnancy that may also risk you out of home birth, in which case the midwife will, again, refer your care to an obstetrician. In Colorado, direct-entry midwives are not permitted to care for women who have diabetes, hypertensive disease, certain heart problems, or certain blood problems. (2)
4: What if I have had a previous cesarean section?
Here in Colorado, there are a few requirements before you can legally choose to have an HBAC (Home Birth After Cesarean). The main ones are; a) a span of at least 18 months between your cesarean and the due date of this pregnancy, if you have had only one cesarean; and b) at least one successful VBAC in a hospital if you have had two or more cesareans. Beyond that, this is a very personal decision that is completely up to you. (3)
5: What are my options for pain management in labor if I birth at home?
I’ll put this as simply as I can. The only things you can’t use for pain at home are the drugs available in the hospital. At home, you have access to water (in the bath, a pool, or shower), massage, food & drink, complete freedom of movement, aromatherapy, walking, acupressure, music, and any relaxation techniques you care to try. You are also free to have whomever you want present at your birth, including a doula, if you so desire.
Not to mention the most important aspect of it all – you are in your own home, your comfort zone, and you have complete autonomy over what goes on during your birth. Pain in labor is directly linked to fear and tension, both of which are hard to combat in a hospital setting, unless you are very well prepared for the change in environment from home to hospital.
6: What about the mess?
This is another easy one to answer. The vast majority of midwives clean up after everything is over, and will start a load of laundry before they go. As the birthing family, it would only be your responsibility to provide an old sheet and a cheap plastic shower curtain to protect your bed, as well as copious amounts of chux pads to protect everywhere else. And if you have a water birth – it’s even easier! The mess is all contained in the pool, which is just pumped into the bathtub and down the drain. The tub is then wiped down very well with cleaner, and everything’s back to normal. The mess is really not an issue at all, and honestly, is not necessarily very large to begin with.
7: How is a home birth different than a hospital or birth center?
Basically, birth in most hospitals is treated using the obstetrical model of care, rather than a midwifery model. In the former, birth is treated as an emergency waiting to happen, therefore necessitating all kinds of routine interventions, “just in case.” In the latter, birth is treated as something that simply works, as long as it is not unnecessarily interfered with. Midwives usually view themselves as lifeguards – maintaining a trained, watchful vigilance, and rarely needing to use their life-saving skills.
The other key difference is in your options regarding birth. In some hospitals, there may be very stringent protocols requiring more self-advocacy if you desire something different. When you birth at home, all the choices are yours. Birth centers tend to be somewhere in the middle – balancing the midwifery model of care with the availability of a few more medical interventions.
8: What if I bleed too much?
Midwives are highly trained in recognizing women at risk for bleeding too much postpartum, and are therefore well-prepared when it happens. They can treat excessive bleeding through all the usual methods: Nipple stimulation, via breastfeeding, a pump, or manually; fundal massage, and herbs. There are other options as well, but you would have to ask the individual midwife providing your care what those are.
9: What if the baby can’t breathe right away?
Here in Colorado, midwives are required to have training in the administration of oxygen, and are required and trained to assess the baby’s need for resuscitation. Midwives maintain current certifications in neonatal resuscitation, and are well-equipped to care for your baby in this very rare case. (4)
10: What happens if a complication arises in labor that requires medical attention?
Once again referring to Colorado law, midwives are required to have an emergency plan, and are required to monitor for certain signs in labor that would require transport. (5) The great advantage, I think, in hiring a midwife is this very issue. As a general rule, midwives will spend far more time with you, both prenatally and during labor, building a relationship with you in such a way that she may often recognize signs of trouble long before an electronic fetal monitor or overworked labor nurse could. If there is a need to transfer, midwives will definitely speak up and make that clear, and help you get to the hospital, either via ambulance or your own car, depending on the situation. The rate of transfers is very low, and is rarely for a true emergency.
Home birth really is a viable option for most healthy, low-risk moms. My rule of thumb is this: Never say “Never.” Do not rule out any of your options until you have explored them thoroughly. Talk to midwives, ob/gyn’s, and family practitioners in many different settings before you decide to settle for the status quo. There are also many books, reliable websites, and video resources regarding home birth if you still have more questions. And of course, you are always free to call me! Remember – you have 40 weeks to choose your birth place.
Take your time.
1: “Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.” Published April 15, 2009.
2: “Colorado Midwives Registration Rules and Regulations.” Rule 4, Page 2; Rule 5G, Page 5. December 1, 2009.
3: “Colorado Midwives Registration Rules and Regulations.” Rule 12, Page 14. December 1, 2009.
4: “Colorado Midwives Registration Rules and Regulations.” Rules 3, Page 1; Rule 8, Page 9. December 1, 2009.
5: “Colorado Midwives Registration Rules and Regulations.” Rule 6E, Page 7; Rule 10, Page 12. December 1, 2009.