Considering A Home Birth? 3 Things To Think About

Home birth is becoming more popular these days - which is a funny sentence to type because home birth used to be the norm’ - until it wasn’t. The resurgence of home-births may have happened for a few reasons; with the emergence of COVID-19 in the United States and around the world, many women turned to home-birth because they either did not feel safe in a hospital, or hospital policy did not even allow their spouse or significant other to be with them while in labor. In addition, many women are also starting to notice some discrepancies between typical hospital policy and procedure, and the evidence-based information on normal physiological birth, so instead they opt to give birth at home where they are free to labor and birth how they want to. Whatever their belief or reason, the fact remains: many women are seeking out home birth as a viable option. If you have a home birth already planned for your current pregnancy, or are considering home birth for the future, there are a few things to consider.

1. Consider you and your baby’s personal risks.

When considering a home birth, it is important to consider you and your baby’s personal risks. If a doctor has labeled you “high risk” for any reason, it would be wise to consider those risks and how they may affect you and your baby if you are laboring and birthing at home. Are you or your baby in need of additional monitoring due to high blood pressure or diabetes? Do you have a pre-existing medical condition such as an autoimmune or other disorder that has required extra care or monitoring during your pregnancy? These are all things that should be discussed with your doctor or midwife prior to planning a home birth. Some questions to ask may be “what interventions or treatments are recommended for me during labor and birth, and would they be available to me if I birthed at home? If not, what are the risks of forgoing those in the event of a home birth? Are there alternatives to these treatments that would be possible to administer at home?”

You may also want to consider your baby’s risks as well. If your baby has received extra monitoring during pregnancy or has a known medical issue or issue with the placenta that may require additional or immediate intervention during labor and birth, consider these factors when deciding to go through with a home birth. If you and your baby are in and maintaining good health or are otherwise categorized as “low risk”, it may be wise for you to consider the general risks of home birth and discuss with your midwife what their protocol would be in the event that an unexpected complication or hospital transfer would occur. Regardless of your particular circumstances, it may be helpful for you to use the BRAIN acronym when coming to your decision. Every woman has the right to make an informed decision about where and how she wants to give birth.

2. Understand how midwifery laws in your state may impact your home birth.

While a small percentage of women choose to have an unassisted home birth, it is wise to have your home birth attended by an educated and experienced midwife. However, some states in the U.S. have laws that restrict what type of midwife is able to practice legally in that state. Certified Nurse Midwives are licensed to practice legally in all 50 states. CNMs receive their certification through the American Midwifery Certification Board. There are two other categories of midwives, Certified Midwives and Certified Professional Midwives who are considered direct-entry midwives and who are only recognized and legally authorized to practice in a few states. Understanding your states laws may help you find a midwife and understand any state regulations that might impact how they care for their patients. These laws even govern whether or not your midwife can bill insurance such as Medicaid. Certified Nurse Midwives have the authorization to possess and prescribe certain drugs, even when attending a home birth, such as pitocin, Vitamin K, IV fluids, and RhoGAM shot for mothers who need it. While they are usually brought along as a precaution or if mother or baby need/have requested them, many of these common interventions can be life-saving at home, such as pitocin, especially in the case of postpartum hemorrhage for example.

However, Certified Nurse Midwives are not readily accessible to all. Even in states where Certified Professional midwives can practice legally, state law may prohibit them from carrying these drugs with them. There is a lot of nuance in these state laws, much discrimination in who midwifery care is accessible to, as well as discrimination among skilled midwives themselves. Your best course of action is to examine your state law and find a midwife in your area who is able to practice legally and perform the care you need and desire during your pregnancy, labor and delivery. You can read more about individual state law at https://mana.org/about-midwives/state-by-state .

3. Ensure that your spouse/significant other shares or supports your desire for home birth.

When considering a home birth, it is inevitable that you will have some - at least one - family members or friends give pushback, or even encourage you not to birth at home. These responses may make you feel anxious or isolated, especially if your otherwise tightly-knit family or friend group becomes divided over your decision. Even if you lack adequate support from family or friends, it is very important that your spouse or significant other fully shares or supports your desire to give birth at home. Birth is always intimate, vulnerable, exhilarating and emotionally taxing, but giving birth at home with a spouse who may feel resentment or negativity about the home birth, or continuously projects their distaste for the idea onto you should give you a moment of pause. If you want your birth to truly be enveloped in the comfort of your own home, part of that is ensuring that your spouse is able and willing to support you every step of the way. Effectively communicating why you want to give birth at home, as well as the benefits and value you believe it will provide for your family and your baby, can help your partner better understand your wishes and help him get on board. Be open to dialogue, and perhaps try to do research together, and include your spouse in the educational preparation. It may also be helpful to hire a doula who can help support you and your spouse during your home birth. A doula may be able to help your spouse feel confident in ways to support you during your labor and birth at home, and a doula may also be able to point you and your spouse to educational resources or local support groups that would be of value.

There are many, many other things to consider when you’re thinking about or planning a home birth, but these are the three I chose to include in this post because I feel that personal risk assessment, the right provider, and support from your spouse are of absolute utmost importance in achieving a safe, comforting and calm birth environment at home. The hospital may be full of additional stressors, but your home can also be a place of unrest during birth if you have not prepared adequately or have people on your support team who are not a good fit or who don’t share your birth philosophy. As a doula, I am passionate about helping people make informed decisions and feel confident about their choices, and this includes my clients who choose to give birth at home.