Why Homebirth?
Common Questions About Home Birth:
What exactly is a "Midwife" anyway? Midwives are skilled birth attendants specializing in physiologic pregnancy, birth, postpartum, well-woman, and early newborn care. In the United States, it can feel a little confusing! There are various types of midwives, trained in various ways, with various titles. In addition, each state has its own laws outlining education, training, & legality. TM, "Lay" TBA, LM, DEM, CPM, CNM, & CM are all acronyms that mean midwife! A midwife's experience & scope and style of practice may differ depending upon all of these factors.
In the state of Ohio, there are Certified Professional Midwives (CPMs), Independent or Community Midwives, also known as Direct Entry Midwives (DEM), who are trained by apprenticeship, and Certified Nurse-Midwives (CNMs).
Most (but not all) CNM's are hospital-based care providers and CNM's are the only midwives allowed to practice directly in the hospital system, sometimes in conjunction with or under the supervision of an Obstetrician, although the laws allow for independent practice. A few CNM's practice in birth centers or home birth practices. The majority of homebirth midwives are CPM's, a national certification, specializing in out-of-hospital birth, certified via the North American Registry of Midwives (NARM). Some CPM's choose to be licensed while others do not, while a number of other midwives choose the less-regulated path, training and practicing as DEMs or other designations. Ohio currently doesn't offer licensure, meaning it is legal for all types of midwives to practice, regardless of certification or licensure status. Each of these types of midwives and midwifery designations have their positives and negatives (most midwives have specific reasons for choosing their particular path) and each serve families seeking midwifery care in their own unique ways. The very best way to find out which midwife is best for you and your family is to talk to the midwives in your community. Ask us what you want and need to know! As confusing as some of this is, Ohio law clearly supports the autonomy of birthing families, and Ohio families seeking midwifery care have a lot of wonderful options to choose from. To learn more, check out these local resources.
Is Home Birth Safe? While naysayers and study cherry pickers abound (typically with their own agenda drums to beat), to date, there are multiple studies that indicate the safety of planned home birth for low-risk mothers, particularly with a trained midwife. There is also data indicating that some women with even moderate risk can safely birth at home. Worldwide, there is a growing push towards developing and educating more midwives, and midwives are known to have a positive impact on both maternal and neonatal mortality and morbidity rates. We know that birth practices that support and encourage physiological birth (meaning those that support normal body processes in pregnancy, labor, birth, and breastfeeding) are the key to safety and wellness for birthing families, regardless of place of birth. We also know that home birth, and the midwifery model of care, by its very nature, offers families a greater likelihood of experiencing these protective practices.
Risk assessment is an important part of home birth preparation for both the birthing family and the midwife. It is necessarily both broad and individualistic and includes a view of statistics, personal health, and birth history, personal accountability & informed choice, as well as perception of safety, excellence in midwifery education and training, and preferably, community support for families choosing midwifery care, as well as support for those same families and midwives in accessing referral services and respectful transfer of care when desired or medically necessary. While it is clear that some risks are absolute, it is also true that safety does not always mean the same thing to every family and that often safety, risk, and benefit are presented in narrow confines that do not take into account all the various dimensions, or stake-holders, in decisions made and care offered during pregnancy, birth, and the postpartum.
Should I have a Home Birth? Yes. No. Maybe? That is a question only you can answer. Like many midwives, I am not in the habit of trying to convince anyone that home birth is right for them. There is a lot to think about and the reality is that not every family is going to want to or feel safe or secure birthing at home. Instead, I enter into conversation with potential clients to learn about their desires, potential challenges or health issues, and to honestly answer questions and concerns. I can point you towards resources for educating yourself and explain how I handle normal healthy birth, as well as situations that depart from normal, including rare emergencies and the tools I carry to assist with those. The best birth scenarios are those in which the birthing person feels safe, supported, & respected. She trusts her own body and the process of birth & knows she can lean on her own strength, as well as her care provider, family or other support people for knowledgeable reassurance, and to help her stay grounded if labor becomes intense or plays out in ways she did not expect. Pregnancy, Birth and Postpartum are deeply personal experiences and regardless of where you choose to birth or with whom, it is worth it to spend time and energy figuring out what matters most to you.
Isn't Home Birth messy? So many people are worried about the mess factor, but the answer is, not really. While various body fluids are a part of the birth process, usually people are surprised by how little "mess" there is (we midwives are really good at containment!) In any event, while you are busy greeting and getting to know your beautiful new baby, your midwife and her assistants clean up any mess that happens and leave your house looking just as it did before your birth.
Can I have a waterbirth? Water is a wonderful tool for labor and birth and most people benefit from its use. Deepwater immersion increases relaxation and comfort and allows the birthing person easier pelvic mobility, as well as the benefit of warmth on gently stretching tissues. Most of my clients plan on using the tub during labor and many of them go on to birth in it, as well. Waterbirth is one of the many topics & choices covered in our prenatal appointments. For more information: Waterbirth, International: 'Easier for Moms, Better for Babies (TM)'
My partner/husband/wife/mother/in-laws/best-friend think I'm crazy for wanting a homebirth. What should I do or say? Most of the time, these concerns are rooted in love and mixed up in safety fears and a misunderstanding of what home birth and midwifery care have to offer. Clear communication and empathy go a long way in these situations, understanding that each of us brings our own stories to the table that inform our feelings about and experiences with birth. Our family and friends are no different! Sometimes this communication means staying clear in your intentions while keeping communication open, while other times, you might choose to discuss your plans only with people you know will be supportive, or with no one outside your home at all. Partners or spouses need to know that their beloved and their baby will be cared for safely and gently and it is difficult, if not impossible, to plan a homebirth without their support. Indeed, to choose homebirth is to take on a much larger responsibility. In my practice, the birthing person and any partner or spouse (unless they will not be present at the birth) must be supportive of the homebirth plan. However, one of the wonderful things about Midwifery care is the development of the midwife-client-family relationship. There is time to talk; time to question and discuss all of the myriad details and to develop trust and confidence. In this way, we all come together, and it is often the most reticent partner or spouse who becomes the most ardent supporter of midwives and homebirth! It is also very beneficial to have anyone else you plan to have at your birth, available to attend an appointment or the home visit around 36 weeks. Ultimately, the birthing person must decide both where they will birth and with whom.
What if I need or want to go to the hospital? Prenatal care appointments include thorough discussions about what to expect in various scenarios, including normal processes, as well as less-common complications or emergencies. If there is any indication that the laboring person or their baby is not tolerating labor normally or if there are complications that are not easily managed in a home setting before, during or after birth, or if a laboring mother changes her mind about staying at home for birth, we simply transfer to a local hospital and transfer primary care to a hospital-based birth care provider. We will accompany you and continue to provide labor support throughout. Most commonly, we continue on with midwifery postpartum and well newborn care, upon discharge.
Home Birth & Midwifery Links
Midwives of North America (MANA) Home Birth Research: Compilation of research on the safety of Home Birth
"Staying Home to Give Birth" and Stand and Deliver
"Flaws in Home Birth Research May Mislead Parents & Providers": Research update from Science & Sensibility
Citizens for Midwifery: 'National consumer-based group promoting the Midwives Model of Care'
Midwifery Today Magazine: 'The Heart & Science of Birth' and MT's 'Information for Parents for the Childbearing Year'
Gloria Lemay: 'Birth Blog'
More Babies Prefer Homebirth: Homebirth
Family Birth/Freebirth/Unassisted Childbirth
Some families choose to birth at home without a midwife. Although this is a fairly unusual choice, there is some excellent information available for families seeking this option or just interested in reading more.
Unassisted Childbirth: Laura Shanley's Website
Preparing for Unassisted Childbirth: From Birth Without Fear