Considering a Home Birth? Here's What You Need to Know
If you're wondering if a home birth is right for you, you likely have some questions. You're wondering if it's safe. If you need a midwife. What's involved. How to create a backup plan. Read more to find out if a home birth is the right birthing method for you.
Why to choose one
Women choose home birth for an array of reasons. You might choose one if:
You want to give birth without medical intervention like an epidural.
You want to give birth in a place that's familiar and comfortable, surrounded by children, family and/or friends you love.
You want the one-on-one care offered by a home-birth provider.
You want to avoid an unnecessary cesarean section. "Women who start their care with a home-birth midwife have a cesarean rate under 10 percent regardless of where they ultimately birth, versus the current U.S. cesarean rate of over 32 percent," says Hilary Schlinger, CNM, MS, CPM-ret.
You have religious or cultural issues that may be better addressed by giving birth at home.
You're having a healthy, low-risk pregnancy. You may not be low risk if you're having multiples, your baby can't be born head first, you have chronic high blood pressure, you've experienced or are at risk for preterm labor or you have diabetes. "Review your medical and reproductive history thoroughly with your midwife to ensure you're a good candidate for home birth," says Risa Klein, certified nurse midwife, OB/GYN NP, MS, who is known as The Manhattan Midwife.
Your hospital doesn't provide the options you want. "Some women chose home birth because their hospital doesn't provide something they want—water birth or true access to VBAC (vaginal birth after C-section)," says Robin Elise Weiss, PhD, MPH, CPH, LCCE, AdvCD(DONA) and author of many pregnancy books. She says that while research says that more than 80 percent of women with a previous C-section would be great VBAC candidates, some hospitals or physicians refuse 100 percent of people from making that choice. Kentucky, for example, has just over an 8 percent VBAC rate.
You and your partner are both on board. "The emotional aspects of choosing to give birth at home are often overlooked," says Klein. "Couples that aren't emotionally and philosophically on board with one another can have challenges."
Preparing for a home birth
Choose a health care provider. Select a certified nurse-midwife, a certified midwife or a certified professional (a midwife whose education meets specific standards or a doctor practicing obstetrics within an integrated and regulated health system), says the Mayo Clinic. The practitioner should have access to consultation with doctors or specialists at a collaborating hospital. Research the practitioner's background, education and recommendations, says Klein. If you choose a group practice, "Meet each midwife in the practice in an effort to feel comfortable with all your midwives," says Klein.
Learn more about Choosing a Midwife: What You Need to Know
Devise a birth plan. Hash out the basics. Consider if you'll use any pain medications, if you want to labor in a bathtub and if you'll breastfeed after delivery.
Get the right supplies. Your midwife will give you a list of supplies you'll need to purchase, says Klein. Midwives typically provide medical supplies such as IVs, oxygen, baby scale, sterile gloves, waterproof covers, gauze pad and a thermometer.
Prepare for a hospital transfer. "A backup plan to a nearby hospital is an absolute priority in the event a medical challenge arises for mother or baby," says Klein. You may need to go to a hospital if labor isn't progressing, you're bleeding, baby shows signs of distress, baby is breech (rather than head first), you need pain relief or you develop high blood pressure. Ensure you have transportation. And ask your health care provider to make arrangements with a local hospital so you can be transferred and treated if needed. "One of the more common reasons to transfer to a hospital is it's not an emergency," says Weiss. "That's usually because the pregnant woman is tired and wants an epidural." Or, labor stalls out. "That's when the woman may require some medication to augment her labor,: says Michelle Collins, PhD, CNM, FACNM, FAAN, professor and director, Nurse-Midwifery Program at Vanderbilt University School of Nursing in Nashville.
Check your insurance coverage. You may have to pay out of pocket for your midwife depending on what state you live in, your insurance coverage and your home birth midwife, who may or may not take insurance. Some insurance companies will pay or reimburse you for home birth costs. "Sometimes people have insurance that covers a hospital birth at 100 percent or even at 80 percent but may or may not cover a home birth," says Dr. Weiss. She says that some families use flexible spending account or health savings account monies, and others pay out of pocket.
Find a pediatric provider. Choose a health care provider who can see the baby within 24 hours after you've given birth.