1. Research your options. It's extremely unlikely that you'll find an ob-gyn to be your birth attendant. By training, they're taught to treat birth as a medical event with potential complications. In some states naturopathic physicians do a lot of home births. But a midwife is your most likely candidate. Most home births are attended by direct-entry midwives, as opposed to certified nurse-midwives.  [Erika's note: When you choose to have a homebirth, you choose to take responsibility for your birth.  Be informed.  Research the pros and cons of any test your Dr./Midwife requests.  Ask questions, use the Internet, read, make sure your nutrition is the best it can be.  You can and will prevent a lot of unnecessary problems simply by taking good care of yourself.] 

2. Pick a practitioner with solid experience. When interviewing, be sure to ask how many births she's attended, both as a primary (where she was in charge) and as an assistant. You want someone who's been the primary birth attendant in at least 100 births, says Chris Ann Beard, a certified nurse-midwife in Portland, Oregon. Make sure the midwife works with an assistant (most do).

3. Make sure the practitioner is comfortable handling emergencies and is bringing appropriate equipment. Ask specific questions about the range of complications she's handled. She should have the knowledge and equipment necessary to resuscitate a newborn, administer medication to stop a postpartum hemorrhage, and suture a severe laceration.

[Erika's note: In Ohio, direct entry midwives may not carry Pitocin or any other prescription medications.  Most use herbs and uterine massage to control postpartum bleeding.  Midwives will use several preventative measures to greatly reduce the changes of a laceration as well as bleeding.]

 

4. Have an emergency plan. Ideally, your midwife should have a relationship with a physician or hospital in case the home birth doesn't go as planned. If she doesn't have a doctor she can call to describe what's happened and warn of your arrival, you'll basically be treated as an ER patient, notes Beard. The doctor and staff won't know anything about your medical history, and they will likely be very worried about you and your baby. This often results in more tests and interventions, the very thing many women want to avoid.

[Erika's note: You may opt for what is known as "co-care".  When you choose co-care, you see a certified nurse midwife or an OBGYN throughout your pregnancy in addition to seeing your direct entry midwife.  In the event that you require transport to the hospital, you have already established a relationship with the doctor of your choice and all your prenatal testing has been done.  This option ensures that you will receive care from the care provider(s) you have chosen and will reduce the chances of unnecessary interventions.  You will also want to ask your midwife if she will accompany you to the hospital in the event of a transport.]

5. Decide where you're going to give birth and who will attend. Depending on how far away you are from a hospital, you may choose to go to a friend's or relative's house once you go into labor. That way, if there's an emergency, you can get to a hospital quickly. There are no rules on how many people should be present at the birth. Whether to include children, family, and friends, or just yourself and your partner (plus the birth attendant and her assistant of course!) is up to you.

6. Consider having lab work and tests done through a clinic. Home birth patients sometimes have all of their prenatal lab work and ultrasounds done through a doctor's office, often on the midwife's recommendation. That way their insurance is put to some use. And if the patient ends up being transferred to the hospital, the medical records are already on file. [Erika's note: Again, this is where co-care would come in.  Your CNM or OBGYN would run any lab work and prenatal testing that you consented to.]

7. Check what your insurance will cover. Many insurance plans don't reimburse for home births. In general, the fee ranges from $500 and $2000, which usually includes prenatal care and six weeks of postpartum care. [Erika's note: The cost of homebirth services varies greatly from midwife to midwife.  In my area alone the range is from $400 to $1500]

8. Understand there is risk.  Carl Jones says, and I concur, "No one can tell a mother she is perfectly safe giving birth at home. Whether she is safer at home than in a hospital, however, is another question". There is always going to be some risk when giving birth, as in all of life, and women should be carefully screened for any health problems that could be dangerous during labor and delivery. For certain women in rare instances, obstetric care is essential. However, for most women, better, healthier results are seen when mothers chose birth centers or home births. As far as the risk of home birth goes, Our Bodies, Ourselves states, "The times when hospital care unexpectedly becomes instantaneously necessary are rare". In A Good Birth, A Safe Birth, Diana Korte and Roberta Scaer quote Tew, the research statistician, who says, "The danger of home as a place of birth does not lie in its threat to the healthy survival of mothers and babies, but in its threat to the healthy survival of obstetricians and obstetric practice". 

• Dr. Lewis Mehl did a study comparing home and hospital birth with mothers from California and Wisconsin with matched populations of 2,092 mothers for each group. Midwives and family doctors attended the homebirths; OBGYNs and family doctors attended hospital births. Within the hospital group, the fetal distress rate was 6 times higher. Maternal hemorrhage was 3 times higher. Limp, unresponsive newborns arrived 3 times more often. Neonatal infections were 4 times as common. There were 30 permanent birth injuries caused by doctors (Jones 99).
• Dr. Mehl did another study comparing 1,046 home births with 1,046 hospital births. The groups were matched for age, risk factors, etc. There was no difference in infant mortality. None! However the hospital births caused more fetal distress, lacerations to the mother, neonatal infections and so on. There was a higher rate of forceps and C-section delivery and nine times as many episiotomies.

9. Search online. To find a midwife who does home births, log on to www.mana.org,  the Web site of the Midwives Alliance of North America or The North American Registry of Midwives at www.narm.org . You can also check with www.MidwifeInfo.com . Word of mouth is also a good method.