9 Tips for a Successful Home Birth

By Kate Kelly

What you need to know about home birthing.

Many women contemplate giving birth at home because they want to avoid the high-tech atmosphere and interventions of a hospital. You're a good candidate for a home birth if you're in good health and have an uncomplicated pregnancy. Still, most expectant mothers don't get past the thinking stage -- home births account for less than 3 percent of all births. Here's what you need to consider if you're thinking about this option.

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:; While this is a good guideline, experience isn't everything. Education and apprenticeship count too. A newer midwife will be on the cutting edge of research, will probably spend a lot of time answering your questions to ensure everything is normal and will often charge significantly less.
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).; Erika's note:; While this is a good guideline, experience isn't everything. Education and apprenticeship count too. A newer midwife will be on the cutting edge of research, will probably spend a lot of time answering your questions to ensure everything is normal and will often charge significantly less.
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 $2200.
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"
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 a www.narm.org. You can also check with www.MidwifeInfo.com. Word of mouth is also a good method.