Midwife Assisted Homebirth: A Beginner's Guide
- Bethany Roberts
- Jan 12, 2024
- 8 min read
Updated: Feb 18
There is hesitation combined with excitement that comes with writing this blog post. I always try to be cautious when I speak about homebirth because I never want to make anyone who has experienced (or will experience) a hospital birth (whether by choice or by necessity) to feel like they are less of an individual because they did not experience a homebirth. I support Mothers at home and at hospitals, and I want each and every one of them to feel confident and empowered by their decisions. Hospital births have a large place in our society today, and out-of-hospital births are not available to everyone.
I do, however, want any Mother who is interested in exploring the less-understood world of homebirth, to be able to find resources and information on the subject. I've shared before that my first midwife was found on Google, and I didn't know much more than that about the homebirth community in my area. The Lord guided my way and I had an amazing experience, but I look back in awe at how little I did know with my first birth!
To break this subject down into categories, I'm going to go back to the old "Who, what, when, where, why and how" guide that we all learned in school. Enjoy! ♡
Who can have a homebirth?
What makes you a good candidate for a homebirth?
This is a somewhat broad and debatable question.
Should first time Moms avoid homebirth?
What about VBAC Moms?
What about Moms labeled as high risk?
A lot of these answers will depend on a homebirth midwife's own comfort level and set of standards for her practice if she is not state certified, and will also depend on state laws surrounding her care if she is a state licensed CNM or CPM. (https://mana.org/about-midwives/types-of-midwife)
Here is a study on the safety of First-Time Moms compared to multiparous Moms delivering at home: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext
No major difference was found between the two groups, and the study found that no maternal deaths were reported in either group among the nearly 50,000 women included in the six studies that explicitly reported this outcome.
More on First-Time Moms birthing at home:
"Despite care by the same midwives, first-time mothers who chose to give birth at home were not only more likely to give birth with no intervention but were also more likely to receive evidence-based care."
VBAC Moms:
In America's Healthcare System today, Cesarean rates are high, and providers willing to provide true VBAC support to women can be hard to find. Homebirth midwives, however, are typically willing to provide supportive services for Moms who would like to experience a VBAC. Here is a great article summarizing the details of HBAC:
Addition to this blog post on 04/13/24:
Studies on success of VBACs in hospitals versus homebirths:
Of the 601,537 women in this study, the final mode of birth was VBAC for 78,874 women, representing a total VBAC rate of 13.1%
A recent German study found that women planning an out-of-hospital VBAC (birth center and homebirth) had a 77.8 % success rate compared to in-hospital VBAC of 32 % in the same region [21].
Per the March of dimes - In the United States in 2022, the rate of vaginal births after a Cesarean (VBAC) was 14.6 per 100 live births.
This sample included 1054 women with a history of cesarean, and these women had a vaginal birth after cesarean (VBAC) success rate of 87.0%. Of the 915 successful VBACs, 94% were completed at home. A total of 222 newborns in a breech presentation were born vaginally (57.2%) or by cesarean (42.8%) (Table 3).
High Risk Moms:
This is a category without a black and white answer in a blog post. Some high risk categories like Gestational Diabetes and High Blood Pressure can be controlled by diet successfully. Some things that would be automatically considered high risk by an OB practice (like twin pregnancies) may not be considered high risk by a midwife. Some high risk pregnancies need to take place in a hospital and cannot be controlled by diet or other alternative methods.
Dr. Stu and Midwife Bliss have a great episode on their podcast, Birthing Instincts, on twin birth that details ACOG guidelines and evidence-based research on twin pregnancy care. Here's the link: https://open.spotify.com/episode/3iO17WpSvs8xcAJ5YFfKwl?si=ChLFmm-HSPWp2u5KyEkXVw
I will also add that breech birth is another common type of birth that homebirth midwives are generally more willing to support than OBs. OBs are generally not trained to perform breech births anymore, and a lot of midwives are continuing the practice of vaginal breech delivery by attending training seminars on the subject and insuring that they have the skills to provide this service. Breech can be a variation of normal, just like some twin births.
When you get ready to hire a midwife, I would recommend interviewing more than one midwife and exploring all of your options when it comes to choosing one for a homebirth. Most midwives provide a consultation free of charge or at a low rate to help you determine if they're a good fit for you. If you need recommendations of midwives for your area, contact me or visit the bottom of my page where my Resource List is posted.
What does care from a homebirth midwife look like?
My favorite part of having a homebirth midwife during my pregnancies was the laid-back, comfortable atmosphere of my prenatal appointments. Each appointment lasted for an hour, and gave me plenty of time to remember what questions I needed to ask, and for my midwife to observe any areas where I may need assistance. I was also able to bring my children to each visit, and they played with toys provided in the office, listened to the baby's heartbeat and ate a ton of lollipops at my midwife's expense. 😂 She never acted bothered by them at all, and I was so grateful for that. Not everyone has a babysitter at their disposal every time they need to go to an appointment for a new baby! I was also welcome to have my children at the birth as long as they had a person in charge of them in case of an emergency. I absolutely loved how pregnancies were a family affair with my my homebirths.
My medical care was very hands-on. My midwife never needed an ultrasound to know where my baby was positioned. She was well-trained in palpation, and could even tell the approximate weight of my baby that way! She also never pushed anything that I didn't want. She did have things that would make her more comfortable, like knowing my GBS status even if I declined antibiotics, but I was willing to do what made her feel comfortable because of our relationship, my respect for her, and my trust in her judgement.
No intervention was over-used in my pregnancies and births. My midwife practiced hands-off until hands were needed, and then she was well-prepared to use them.
Speaking of being prepared, my midwife didn't show up at my homebirths with a little black bag and a stethoscope. She showed up with huge tool boxes full of emergency equipment including a baby resuscitation board, medication in case of postpartum hemorrhage, and a huge oxygen tank. She would lay out a tray of needles and medication that would make my skin crawl at the sight of it (I despise needles!) , but thankfully, none of those were ever needed at my births. Her gentle hands were my most-used medical assistance. 💓
When can you decide if you'd like to give birth at home?
Well, I didn't decide this until I was between 28 and 32 weeks pregnant with my first baby. I walked out of my OB office at 28 weeks so furious that I determined to never step foot inside the doors again. I was completely finished with being belittled and ignored when I wanted to take charge of my own pregnancy and birth. I wasn't an exemplary patient because I asked too many questions and didn't just follow the typical protocol. The tipping point was presenting my birth plan and having it "shot full of holes" so to speak. In the same visit, the phlebotomist in the lab told me that if I wanted to kill my baby by declining testing that was fine with her (This nasty comment was the result of me asking for a print-out of what they were testing me for that day, and I never said I was choosing to decline anything!)
I knew I wouldn't get the birth that I wanted unless I switched providers.
With that being said- homebirth midwives take on a limited number of clients per month, and the sooner that you can contact one and reserve your spot, the better!
Where are homebirth midwives available?
Some areas of the US have a lot less midwives that perform homebirths than others, but typically, they're available in most areas, but may be hard to find, or may require traveling a bit. A few good places to start your homebirth midwife search is your state midwives' association website, state homebirth Facebook groups, or asking local birth workers such as Doulas or Lactation Specialists about the midwives available for homebirth in your area.
Why would I choose homebirth over a hospital birth?
If your desire is to birth as undisturbed as possible, with as few interventions as possible, homebirth is for you.
If you desire individualized maternity care, homebirth is for you.
If you want less risk of a cesarean, homebirth is for you!
If you want to birth in any position that feels right, not be strapped to monitors, and not lay in a hospital bed, homebirth is for you!
How safe is homebirth?
Homebirth doesn't have a large amount of participants when compared to the general amount of women giving birth, and motivation for safety studies isn't immense, so this area is limited.
I have managed to find some studies, though, and I'll link them below. Determining whether homebirth is the safest option for you is an individual decision, and definitely shouldn't be taken lightly. On the other hand, being aware of common interventions and protocol at your local hospital and with your neighborhood OB/GYN should be taken into consideration as well. There is a reason there is a term "cascade of interventions".
The Studies:
How much is homebirth?
Pricing will vary from midwife to midwife, but typically, homebirth costs are less than $10,000.
Depending on your area, you're probably looking at around $5,000 after bloodwork, anatomy scan and Midwifery Services. Insurance typically will only cover a portion of homebirth costs after you've paid your midwife (typically due by 35 weeks of pregnancy) and submitted a claim, and some will not pay at all. Some midwives have a billing service and will submit claims for you as well.
If you can't afford a midwife, don't be discouraged! Look for out-of-the-ordinary ways to fund your homebirth! Some midwives will barter for part of their costs. You could also consider asking for donations to go towards homebirth in place of gifts at a baby shower or sprinkle. I took out a loan against my first car- a 2001 Mustang- to cover my first homebirth! Where there's a will, there's a way!
If you have any questions about homebirth that are not answered in this blog, please contact me! I may not know the answers, but I will do my best to help you find them!
All the best until next time!!
♡ Bethany
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