Hey fam!

I wanted to write this month’s newsletter for those of you who are considering a homebirth, on the fence about a homebirth, or absolutely terrified at the thought of considering a homebirth. Sometimes when we lift the veil and we demystify something, it becomes more accessible, relatable, and less anxiety provoking. So, below are a few questions that you sent in that are some common questions folks have about homebirths. There were so many similar ones, so I consolidated them. If any of these questions spark some additional questions, feel free to book a consultation with me to discuss your options and seek guidance with your homebirth journey.

Where do I start?

It’s important to note that while I absolutely LOVE homebirths, I recognize that homebirths are not suitable for everyone. Hospital births were really made for high risk labors that require more monitoring and possible surgical intervention. However for those pregnancies that are healthy and low risk, you may very well be eligible for a homebirth. Most people start out seeing an OBGYN for their routine prenatal care. Fun fact, a midwife can also see you for routine gynecological care. If your plan is to inquire about a homebirth, the best place to start is to find a licensed midwife and eventually switch your prenatal care over to them. Your midwife can guide you with information about homebirth laws and regulations in your local jurisdiction. Homebirths are not only for people who rent or own a home. Folks can choose to birth in apartments, shared rooms, vacation rentals, or hotel rooms. I’ve seen it all. You want to choose a location where you know you’ll be comfortable, with minimal interruptions.

How do I find a midwife?

I highly recommend interviewing ALL of your medical providers, including your potential midwife. You want to make sure that your provider aligns with your values, is ready to support your goals, and is open and honest with you when they need to share difficult information. Finding a midwife is as easy as starting with a quick Google search of local homebirth midwives. I would say that you could ask your doc for recommendations but in my experience, they don’t always seem ready to refer their patients to homebirth midwives. No shade docs. It is what it is ::shrugs::

If you’re a member of some birth-related online groups and forums, you can ask for recommendations there. Also, if there are birth centers in your area, that is another great place to find local midwives. I posted on my blog a list of interview questions that you could ask your potential midwife. It is a pretty long list so I advise folks to pick and choose which few questions are vital to you in the 30-60 minute initial consultation and then you can save the other questions for your subsequent visits. Midwives work in community with other midwives and birth assistants, so you’ll want to know what package deal you’re getting when you book.

How much does a homebirth cost?

According to a 2021 NIH study, “On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth.” With homebirths, there are a couple of things to consider in addition to the main midwifery fee. There are many midwives who require a birth assistant (BA) to work with them. You may want to ask if the BA fee is included or if that’s a separate cost. Usually the doula is also a separate cost. Lastly, you will want to budget for purchasing all the homebirth materials that you don’t already have in the home; birth pool rental and water hose (optional), extra towels, extra linens, waterproof bed sheets, postpartum pads and briefs, etc. Typically the family also provides a community meal for the family and birth team, which comes in handy during the long overnight hours of labor.

What happens if there’s an emergency?

This depends on what kind of emergency. Firstly, there is a lot of pre planning before the actual homebirth so that you and your birth team have a detailed strategy for any emergencies that may arise prenatally or during the immediate postpartum. Whereas with hospital births, baby’s vitals are typically monitored continuously, during homebirths, there are intervals for monitoring. This allows the parent to have free range in the home and not be so focused on the numbers and stats but rather what is happening in their body. Again, for low risk births, intermittent monitoring is absolutely safe.

So if any kind of emergency arises during labor, it’s usually caught during monitoring, proceeded by a swift response from the midwife and their team. Homebirth midwives roll deep with their equipment and medications. They have tanks of oxygen, suctions, medications to navigate pain management (not to the level of an epidural though yall) but just enough to take the edge off during early labor, and basically everything they need to monitor your and baby’s vitals, provide IV and suturing if needed, and all the components for the newborn exam.

If something happens that requires a hospital transfer, the midwife and your birth team would have already mapped out the nearest hospital to go to and the mode of transfer. For non emergency transfers, usually a member of the family/birth team would transport the birthing parent to the hospital. For emergencies that require a higher level of care, an ambulance transport would be called in. This is very rare in low risk and healthy full term births. The factor that I appreciate most about the homebirth midwives that I’ve worked with is that they are incredibly skilled at identifying a risky situation during a homebirth BEFORE it becomes a serious issue. That way, everyone is involved in a discussion, making a decision, and executing the plan.

Who all gon be there?

This is absolutely up to you. I usually advise folks to be very discerning about who you invite to be in your space during labor and birth. Their presence, energy, and input can impact labor progression. You are not obligated to invite folks just because of blood relation or longstanding relationships. Protect your peace. Regarding the hired birth team, you typically have the midwife, birth assistant, and doula there. Invite a support person who is committed to be by your side throughout the whole process, it could be the co-parent or could be a dear friend/family member who is aligned with your goals. You may also invite someone who can manage other children or pets in the home, and someone to coordinate food and light cleaning of high traffic areas. I like to call them the birth elves. Children are fed and occupied, pets are walked and fed, food magically appears, trash gets thrown out, and the kitchen, bathroom, & living room look immaculate.

What happens after baby is born?

Magic happens! First your midwife and medical team will assure that baby is showing signs of alertness and responsiveness (crying, good muscle tension, good blood flow). Typically delayed cord clamping is a standard practice in homebirths. Baby stays on the chest receiving skin to skin while parent and baby’s vitals are taken. Midwife is focused on the birth of the placenta, and so once that happens, routine vitals continue to be taken. Routine fundal massages (argh) are done as well, to help manage bleeding and expel clots. If there was any perineal tearing, the midwife will focus on suturing that repair and managing bleeding.

Then there’s the much anticipated “golden hour” where the birth team allow the parent(s)/family to be together as a family, encourage bonding and rest, try breastfeeding, and the birthing parent usually gets their first postpartum meal during this time. Vitals are taken intermittently but typically no other medical assessment/intervention is done during this rest/bonding time.

Once that time passes, then the midwife does a full newborn exam. I love this part so much because they use this as a teaching moment for the family members present. Midwives take the time to walk the family through each of the newborn assessments and encourage them to ask questions. They also walk parent(s) and families through the placenta exam and educate them on what a healthy placenta should look like. It’s these teaching moments that make such an impact for parents as they start their postpartum journey.

The birth team encourages parents to choose a pediatrician before birth, so that once baby is born, the midwife can update your baby’s doc, and you can follow up with a Peds visit within 48 hours of birth. Now, regarding homebirth postpartum care, it differs from midwife to midwife. Typically though, they visit the home and follow up on healing, recovery, and chestfeeding support within 24 hours of birth, week 1, week 2, week 4, week 6, and a few extra visits beyond that. Isn’t that amazing! 

I can’t wait to hear your feedback and follow-up questions. Yall know I’m a birth nerd and welcome all questions. Mostly though I want to debunk many common misconceptions about homebirth, and help folks make an informed decision about their method of birthing. Let me know if you want a Part 2!

Tata(s) for now,

Doula Jo

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