Calm & Confident Doulas, Milla Blindauer, CD(DONA) and Melinda Ferguson, AdvCD/PCD(DONA) collaborated to bring you some important information to consider when choosing an out of hospital birth.

Are you considering a home birth or birthing at a free standing birth center? In our current culture, it seems that delivering your baby at a hospital is the default - but out of hospital birth can be a really great option for many people. There is a lot of misconception out there about home birth and midwives and I would love to go over some of the most common questions that people have.

Katrina and Taylor welcome baby Isla into their family in the comfort of their home, with midwife Lynn Hughes of Rainy City Midwifery in attendance. Many thanks to the family for photo permission!

1. Is it safe?

Research shows that for low risk pregnant people, home birth can be just as safe as hospital birth.

Out of hospital midwives (in Washington these are generally Licensed Midwives, and often Certified Professional Midwives) have a strict list of criteria that you must meet to remain in their care. Your safety is their top priority, and if they have any reason at all to believe that you won’t be safe in their care, they will not hesitate to transfer you to hospital care. Many older studies, showing increased risks for out of hospital births, grouped unplanned births, which can be quite problematic, with planned out of hospital births with a trained midwife, thus skewing the data and results (This link goes through the research quite a bit more. This link discusses the use of less rigorous studies to conclude homebirth is unsafe, while also pointing out well conducted research showing it can be safe).

2. What kind of training do out of hospital midwives (sometimes referred to as “Community Midwives”) have?

Washington state law requires Licensed Midwives to complete an accredited midwifery educational program, which includes participation in 100 or more births and verification of clinical skills and didactic course work. To attain licensure, all LMs must pass a national and a state examination. The MAWS website has more information about the training required to become a Licensed Midwife in Washington. Other states have different requirements, and not all states have a legal option for midwives to practice out of hospital. In Washington, midwives are relatively well integrated into the health care system, able to bill insurance, and have developed relationships with hospital based midwives and OBs for consultation and when transfer of care is needed.

Certified Profession Midwives have their education, knowledge, and experience evaluated and approved by the North American Registry of Midwives (NARM) and must also pass the NARM exam to be certified.

3. How is care different with a planned home birth?

Out of hospital midwives can give you much more individualized care than an OB generally does. They attend each of your appointments in its entirety and generally allot more time for each appointment- often 30 minutes to an hour at each visit. This leads to a much better understanding of what is important to you in your care and during your birth. Midwifery practices tend to be small, just 1-3 midwives, in contrast to many OB groups which typically have seven or more providers in their practice. This means you will have spent a fair bit of time prenatally with the person you’ll have at your birth, rather than whichever OB is on call that day.

Midwives focus on collaborative decision making - making sure you always understand what is happening, and what the risks and benefits of all of your choices may be. They do all this in the most supportive way, and this is something that has really stood out to me with out of hospital care- the decision making about my care is clearly in my hands, with the solid guidance of my midwives.

The birthing room at Sprout Birth Center in Mountlake Terrace, WA

Planning an out of hospital birth also often leads to fewer interventions (see this link for stats around this). On top of all of this, being in the comfort of your own home, or at a freestanding birth center can make for a much more calming environment to give birth in. No fluorescent lighting, much less hustle and bustle and fewer people coming in and out of your room- only those you’ve specifically invited to be in your birth space. You’ll also have a comfortable bed, your own clothes, and easy access to comforting food and drinks of your choice. There is so much benefit to having more control over your birthing space. Another great benefit is that the first follow up appointment after birth is in the comfort of your own home. It can be hard getting out of your house in those early days and this can be really helpful.

4. What about pain management?

Pain management outside of a hospital is definitely different than in the hospital setting. Many people find it easier to avoid pain medication in a more comfortable environment, surrounded by people who really know them, with less going on around them, like monitors and IVs. There are no narcotics or epidurals, but there are some other really great tools. Many people utilize warm water for pain management, whether by laboring in a nice warm tub, or in the shower. Massage, changing positions often, and different breathing techniques can greatly help. Hiring a doula to help with these things is a great idea. In my state (Washington) midwives at birth centers can also provide Nitrous Oxide during labor - this can be an amazing pain management tool. It is short acting and can be started and stopped at any point during labor and used for as long or as little as you may want it.

It should also be noted that you are always able to transfer to the hospital if you find that you need more pain relief than what is available at home.

5. Will insurance cover a home birth? What will it cost me?

Insurance coverage of home births varies greatly from plan to plan. Some will cover all or part of it, and others will cover none. Many free standing birth centers are covered by insurance. Even without coverage, the out of pocket costs are often less than those of an insured hospital birth. A cash pay home birth is usually $1500-$3000 and a cash pay, free standing birth center usually runs around $3000-$5000 (this article discusses the costs associated with giving birth). For an uncomplicated vaginal delivery in hospital the cost can easily be $5000 or more.

6. Who is a good candidate and when is it not safe?

Pregnant people who are considered “low risk” are good candidates for home or birth center birth. However there are a variety of medical situations that would indicate a home birth would not be safe for you. A few of these include: high blood pressure, preeclampsia, pre-term labor, heart conditions, lung or kidney disease, twins, and for most midwives here in Washington a breech baby or previous Cesarean birth. There are more, but meeting with a midwife and going over your health history and pregnancy details is the best way to find out if you qualify. A midwife’s priority is keeping you and your baby safe and they will not take you on if they don’t believe they can do that.

7. What if something goes wrong?

Midwives brings several bags of supplies to a homebirth, in addition to a second pair of hands to help manage any emergent situations. Photo Credit: Jennifer Jackson Rabins

Midwives bring a LOT of supplies to each birth. Photo Credit: Jennifer Jackson Rabins

Many people are concerned about how a complication or emergency would be handled by the midwife. This is exactly what they train and prepare for- how to recognize when a situation is becoming less safe and then either manage that or prepare to transfer. Your midwife will monitor your health throughout pregnancy and arrange for any testing beyond their capacity in the office. In labor, they will monitor your vital signs and the baby’s heart rate to be on the alert for any concerning signs. Additionally, they tend to be much more present throughout labor than a hospital based provider. They are skilled at observing how a labor is progressing and recognizing when something is amiss. They also have a variety of tools, skills and medications for managing a baby in distress (inside or recently born) or pregnant parent developing a problem such as postpartum hemorrhage. When you meet with your midwife be sure to ask them about how they may manage any complications you are concerned about. It’s important that you feel safe and confident that they can handle any complications that may arise.

8. How do I find a midwife ?

A great way to find the right midwife is to search online for midwives near you and meet with a few to see who might be the best fit for you. If you have a doula, ask them if they have any recommendations - most doulas have worked with a lot of different midwives and have some great insight in this area. The Midwives Association of Washington State and Midwives of North America both have lists of member midwives. The Calm & Confident Doulas have a few we know well enough that we want to be sure to give you their website too (in no particular order):

Sprout Birth Center (Mountlake Terrace)

Puget Sound Birth Center (Kirkland and Renton)

Northshore Midwives (Kenmore)

Center for Birth Midwives (Seattle)

Rainy City Midwifery (Seattle)

Midwife Seattle (Seattle)

Moonrise (Mountlake Terrace)

Milla Blindauer, CD(DONA)

Milla is a DONA Certified Birth Doula. After two previous births in the hospital setting Milla recently gave birth to her third son, Garrett ,at Puget Sound Birth Center. She carefully researched her options and found providers she felt were a good choice for her and her partner. Our congratulations to Milla and her family!

Eight Questions to Consider if Home Birth May Be Right For You