Giving birth at home is rapidly becoming a more popular birthing option for families in the United States. Women are choosing to birth at home for all kinds of reasons, including lower rates of intervention and more personalized, holistic care. Although the number of women who actually give birth at home is still very small (less than 2%), home birth has certainly gained a lot of attention (and controversy!) in the last few years.
Despite the frenzy, home birth is still an often misunderstood option, rife with stereotypes like doctor-hating hippie parents and chanting, incense-waving midwives. The real story of home birth differs quite a bit from these cliches, though. If you're curious about what it's really like to have a baby in your home, these lesser-known facts about home birth might shed some light on the model, the process, and the experience.
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There are many misconceptions about the kind of care you receive at home; while it's certainly a different model than in other birth care settings, there are still provisions in case of an emergency.
Certified professional midwives, who are the most common home birth care providers, come with tools, training, and expertise. Marinah Farrell, a certified professional midwife (CPM) in Arizona and the current president of the Midwives Alliance of North America explains:
"Standard of care for midwives for emergencies includes pharmaceuticals—such as Pitocin, or synthetic oxytocin for use in case of hemorrhage, oxygen, IVs, equipment necessary to monitor and record vitals on both mother and baby, and other first aid type equipment. Midwives also carry instruments and have the ability/training to suture and administer medications to the newborn, such as eye ointment and vitamin K, or to the mother, such as Rhogam. Essentially, midwives are trained in the use of standard birth supplies."
Despite the fact that a home birth is usually much cheaper overall than a birth in a hospital or birth center, many families end up paying out-of-pocket for the costs of their midwife. Rules and regulations related to home birth and midwifery coverage are highly complicated and vary a lot based on which state you live in, as well as how and where you get your insurance coverage. That doesn't necessarily mean you will have to pay up front if you are planning a home birth, though.
In states where certified professional midwives are licensed, some insurance companies will pay or reimburse for home birth costs. In some other states, like New Mexico, Medicaid will cover a home birth. You may have to spend a lot of time and energy on paperwork, but having the birth you want and getting it paid for will be worth it in the long run!
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The ick factor can be a source of hesitation for families interested in home birth. You might have visions of your partner fainting at the sight of bloody sheets or be panicked you'll lose oodles of amniotic fluid on your brand new couch. Yes, giving birth in your home will likely involve some cleanup—but the good news is you won't be involved in any of it!
"When we arrive to someone's home, we 'set up.' We make their beds using plastic and have all the medical and comfort items out, as well as sort all the supplies," Farrell says. "This way, when mom births, we are ready! I often say, when I leave a house, 'looks like nothing happened here!' because we also clean up and do laundry and make the house presentable again before we leave."
Planned home births that turn into a hospital birth are more common than you think, and not always because of a sudden emergency. In the UK, it's estimated that one in three planned home births require a trip to the hospital either during or just after the birth.
Lawrence Leeman, M.D., co-director of the mother-baby unit at the University of New Mexico Hospital in Albuquerque, N.M., explains: "I think that one of the most common misconceptions is that transfers that occur from home birth are emergency transfers. Prolonged labor at home without progress, the bag of waters broken for an extended period of time...these are more common reasons for home birth transfers. Most of the births wind up in normal vaginal deliveries, maybe needing some synthetic oxytocin to make the contractions stronger or more frequent."
Of course, that doesn't mean that serious situations can't and won't occur at home. But that's all the more reason to have a well-thought-out backup plan. Dr. Leeman adds that it's vital to have close access to a hospital in case you end up needing more medical care: "It's essential for home births to have a safe hospital to transfer to. It's not safe to plan a home birth where you or your care provider are not willing to transfer to a hospital."
The modern image of home birth—just search "home birth" on YouTube, for many (seriously, many!) examples—is often of a woman squatting in an inflatable pool in her bedroom or living room, pushing her baby out into water. But not all home births are water births!
It's nice to have the option, of course, but it's certainly not required. One of the large bonuses of having a home birth is being able to labor and birth wherever you feel comfortable—if that's your bathtub, your couch, your bed or another location in your home.
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The model of care you receive when you give birth at home is pretty different from what happens in the larger medical system. Instead of the 48-hour hospital stay and the perfunctory six-week visit to give you the all clear to have sex again, your care with a home birth midwife will be more frequent and more detailed. Different midwives have different ways of practicing postpartum, but you'll most likely receive multiple home visits to check up on you and your baby, including several in the first few days and weeks.
Farrell says, of her own practice: "Postpartum visits can easily be one-and-a-half hours. I generally come back three to four times in that first critical week postpartum to help with healing, nursing and the transition to motherhood. We make sure the postpartum period is about the whole person, meaning that while we're doing medical visits, we're also checking in on how this new family is doing, doing referrals if needed, and generally just assessing that everyone is healthy and safe."
Having this kind of involved, personalized postpartum care can make a huge difference in transitioning families to new parenthood.