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Frequently Asked Questions about Homebirth
by Lauri Smit
Q. Is homebirth safe?
A. Yes. Any woman with a normally progressing pregnancy with no complications should expect delivery to go smoothly as well. A research study entitled "Scientific Research on Childbirth Alternative" by Lewis Mehl, M.D. compares 1,046 hospital births with 1,046 homebirths. Couples from each group were matched couple by couple based on a variety of factors, including number of previous pregnancies, maternal age, socio-economic status, educational background, attendance at childbirth classes and individual medical risk factors. The differences between the two groups should answer the safety question for you.
  • Fetal distress during labor - 119 cases in the hospital and 20 at home.

  • Incidence of newborn resuscitation - 52 in the hospital and 14 at home.

  • Birth injuries - 30 in the hospital and none at home. (Most injuries were associated with forceps delivery.)

  • Cesarean section - 8.2% for the hospital group and 0.4% for the homebirthers after hospital transport.

  • Not only does prepared homebirth have a mortality rate as good as or better than hospital births, but homebirth has a much better record in terms of complications and damage to the baby.
For more information about the safety of homebirth, please visit the Midwife Archives.
Q. What are the benefits of homebirth?
A. Childbirth is a natural biological function, not an illness or disease requiring medical intervention. The benefits are endless, but here are a few . . .
  • you are in charge of your birth

  • your body can work at its own pace; you aren't put on any time limits

  • you can eat and drink according to your need; food and drink are not restricted

  • you can cope far better with labor in familiar surroundings with familiar people supporting you; there is no one there you don't want there

  • you can labor in whatever positions and attire you find most comfortable; no stirrups and no hospital gown

  • there are no unnecessary medical interventions at home

  • siblings or other family members can be present and the experience can be very personal and private

  • you or your partner can even "catch" the baby

  • Daddy or an older sibling can cut the cord, which is delayed at home until the cord has stopped pulsating and no longer functioning

  • babies born at home are drug-free and trauma-free due to the gentle handling of a midwife

  • there is less chance of infection at home for you and your baby

  • more time can be taken for you and your family to get to know the baby, instead of him being whisked off to a nursery; all baby exams are done in your presence on your bedside

  • breastfeeding can be more successful because it can be done at your own pace and you won't be interfered with by well-meaning nurses quick to offer a bottle of formula

  • best of all, your midwife is with you at all times; there are no shift changes and there is no one else there having a baby but you.
Q. What are the risks of birthing at home?
A. There is always minimal risk during childbirth anywhere you are. However, if you have a low-risk pregnancy and have had good prenatal care, birthing at home is actually the safest option for you. There is a cascade of interventions at most hospitals that has become routine, sky-rocketing our national cesarean rate to a range of 10% to 50% and even higher at some individual hospitals. While there is a time and a place for medical technology in childbirth, during a normal labor and delivery, they can be the culprit of many problems. A skilled midwife is trained to watch for signs of problems early on and to use minimal intervention when necessary or transfer to a hospital should the need arise.

In the Netherlands, which had the third lowest infant mortality rate in 1973, about 2/3 of all babies were born at home with trained midwives. Transfers to the hospital occurred at a rate of less than 2% for multips (subsequent baby) and 8% for primips (first baby). Holland's cesarean rate was only 2.3% and forceps were used only in about 3% of the births (Special Delivery, Rahima Baldwin Dancy).

Q. Who should choose homebirth?
A. Any healthy woman with a low-risk pregnancy can choose to birth at home. However, you must have a strong desire to birth at home and be 100% committed to it. The most successful homebirthers are those who have a strong commitment to it and who trust their body's natural ability to birth. You must be willing to devote time and energy into finding the right care provider, doing your own research (reading and taking natural childbirth classes), and taking good care of yourself to keep your pregnancy low-risk with the help of a midwife who will educate you on nutrition and low-tech approaches to potential problems. You must feel completely comfortable with the idea of birthing at home before making the decision.
Q. Who should not choose homebirth?
A. Diabetes, thyroid disease, chronic lung disease, severe asthma, epilepsy, clotting abnormalities, congenital heart disease, kidney disease, unresolved sexually transmitted disease, malnutrition, drug addiction, moderate-to-frequent alcohol use and smoking are definite contraindications for homebirth. Conditions arising during pregnancy that may rule out birthing at home are severe anemia, acute viral infection (rubella, cytomegalovirus, chicken pox) or initial herpes outbreak in the first trimester. Consult your midwife or physician.
Q. Who attends a homebirth?
A. Usually a midwife will attend a homebirth, but you might find a doctor or a chiropractor willing to attend. You have your choice of homebirth midwives. There are direct-entry midwives (DEM), or those who have learned on their own and have apprenticed with an older, wiser midwife. There are also Certified Professional Midwives (CPM) who have received certification from a midwifery training school. Then there are Certified Nurse-Midwives (CNM) who go to nursing school first and then to midwifery school. CNMs are the only midwives that can also deliver in a hospital.
Q. Is homebirth legal?
A. No one can arrest you for having your baby at home. However, in some states a midwife can be arrested for attending your birth. It depends on where you live. Some states are neutral and some states completely outlaw it.
Q. Will my insurance cover homebirth?
A. Only your insurance company can answer that. Some do and some don't. It usually depends on whether it is legal or not and if you have to use a network provider. Your best bet is to call the company and ask. You may have to educate them on how much money they will be saving.
Q. How do I deal with the pain since I can't have drugs at home?
A. I highly suggest two things: one, take natural childbirth classes and two, hire a doula or labor assistant. There are many independent childbirth instructors around the country, including those trained in ALACE, Bradley, ICEA and Birthworks. All are online and can refer you to someone in your area teaching their classes. Doulas of North America (DONA) is also online and can refer you to a doula to assist you during your labor and birth. Some of the coping techniques you will learn about are: relaxation, changing positions, massage and breathing. Also important is your attitude and expectations. Like countless women before you, you can birth your baby naturally. Affirm yourself.
Q. What supplies do I need to birth at home?
A. Your birth kit should consist of the following:
  • 4X4 sterile gauze squares
  • bulb syringe for suctioning (if necessary)
  • shower curtain to put over your bed sheet
  • extra bed sheet to put over the shower curtain
  • towels and washcloths
  • baby clothes, diapers and receiving blankets
  • large Chux pads
  • Maxi pads
  • Rubbing alcohol for cord care
  • Olive oil for perineal massage
  • large bowl for placenta
  • ice chips
  • soups, blender drinks, juices
  • flashlight
  • camera and video camera
  • large mirror
  • thermometer
  • Betadine
Q. What if there are complications?
A. A midwife is trained to spot potential problems before they become problems. She will correct the problem using natural techniques. If the problem is not remedied naturally or if she feels that a larger problem will occur, she will suggest transferring to physician care at the hospital. Some midwives have physician back-up while others do not. This is something you will need to find out at the initial interview.
Q. How do I find a midwife?
A. Word of mouth is the best way. Talk to others who have had homebirths and find out who attended their births. A good place to meet others is at La Leche League meetings. Midwifery Today has a directory of midwives who may be able to help you or find someone else who can.
Q. What should I ask a midwife at the initial interview?
A. Finding the right attendant is a big part of having the birth you want.
  • Ask about her training and experience. Get references and call them.

  • Ask her how she would handle complications and emergencies. What would she do if you were bleeding and going into shock? What would she do if the baby wouldn't start to breathe? Can she do suturing?

  • Does she have medical back-up? Does s/he have hospital privileges? Do you need your own back-up doctor? Will she be able to accompany to the hospital if the need arises?

  • What equipment does she bring to the birth? She should have a fetoscope, cord clamps or ties, hemostats for emergencies, disinfecting agent for scrubbing up, sterile gloves, sterile scissors for cutting the cord, Lidocaine and equipment for suturing if you tear. What emergency equipment does she carry? Oxygen? Pitocin in case of postpartum hemorrhage? Any other herbs or medications? Does she have a scale to weigh the baby?

  • What are her procedures? When does she want you to call her when you're in labor? Does she bring an assistant? Does she wait until the cord stops pulsating before cutting it? What is her transfer rate? What percentage of the women she works with tear and require suturing? Will she allow the father to be involved in the birth? Does she visit in the days following the birth? Will she assist with breastfeeding?

  • What are her fees and when does she expect them? Are her fees reasonable?

  • Is she easy to communicate with? Can you get a hold of her when you need her?

  • What is her attitude toward birth? Do you see eye-to-eye? Do you like her and trust her?

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