Home birth is definitely not the norm or for everyone. In fact, there is some judgement and even hostility towards it at times. I want to start off by saying that I in no way think that picking one birth setting over another makes a person better or worse. Before I go into the point of this post (scroll down until you see ••• to skip right to it), I want to explain my journey to making this choice. I have always been intrigued by home birth. Even before I was a mother, it fascinated me and I wanted to do it but just thought that ‘I couldn’t’. We live in a rural area. People around here don’t birth at home much. We don’t have a hospital in our town if there was an emergency. Plus my husband was scared to death of the idea. Excuses. Lots of them. As I had more children it felt more realistic though. I gently (or maybe not so gently but same thing ha) nudged my husband regularly towards the idea. Finally by Baby #4 I got him more on board with the idea of not having a hospital birth and we compromised by planning a birth center birth. With my older 3 children there were big red flags and issues with my prenatal care and their deliveries. From a nurse rolling her eyes at me for coming in because i had extreme swelling, couldn’t feel my hands or feet, and was constantly light head due to a consistent blood pressure reading of roughly 193/118 (I was in fact preeclamptic, btw) to the staff trying to force me to go home when I was in labor with my 3rd child because they said that i wasn’t really in labor. They wouldn’t admit me. They wouldn’t give my husband a pillow or blanket after 11 hours of him sleeping in a cheap plastic triage chair. They were rude and wouldn’t really tend to me or any of my requests. After 13 hours of horrible back pain, I delivered my son in a triage room before my doctor could even make it. I had several other issues along the way with all 3 pregnancies but the final straw with that specific hospital was my son’s birth. It was also what pushed me over the edge with realizing that my long term desire and passion for home birth was valid and it was there for a reason. With our 4th child after a long battle of me pushing a home birth, my husband was all for me using a midwife at a birth center. He had watched the struggles of hospital births and how hard they made things for me. Unfortunately though the birth center risked me out on the spot when my baby tried to come at 29 weeks. We fought preterm labor with her multiple times before 35 weeks. In my research over the years to find a midwife in our area I realized that there was a bigger picture here for me. A reason that I’ve been fascinated with it for over a decade. Even a reason that birth and motherhood in general was my childhood obsession. It wasn’t just about being a mom and having a big family. It was a calling to care for other mother’s throughout their pregnancies and support them/their holistic ways through their births and beyond. Thus leading me to become a student midwife and fighting hard for my own passion to birth at home. I prayed so hard for God to change my husband’s heart on the matter. I knew that ultimately he’d support whatever I decided to do but that wasn’t good enough for me. I needed him on board with it for himself too. I didn’t want it to just be something that he did for me but wasn’t comfortable with it. God did change his heart! After years and years of working on him and praying hard, it did happen and my faith that it would all work out has fallen into place. Not without hardship though. Things didn’t work out or feel ‘right’ with certain midwives. I would instantly get a vibe and know that she wasn’t the one by 60 seconds into the consultation. Brian would get antsy and tell me that he didn’t like her credentials. She’d end up being booked or insanely expensive for our area. We wouldn’t like her attitude towards my desire to have my children near by during the birth. She wouldn’t be quick to get back with me. Other midwives would shutter when they’d hear her name. One had even had her license revoked in Arkansas for negligence and lied to me about it. I only found out because I took it upon myself to research each midwife on my own. Things like that. Hurtle after hurtle of certain things not working out only to work out perfectly in the end once we found ‘the one’ or two in my case but I’ll get deeper into that in my next post about birth affirmations. Here is my advice to families seeking the care of a midwife:
•••Firstly let’s talk about what a midwife is and what types of them that there are.
A licensed midwife (LM) is a midwife licensed and regulated by a certain state. Not all states require licensure or are regulated by the state health department. It is up to you to find out the law’s and regulations for your state. In some states such as Georgia and California the only legal home birth midwives are nurse midwives which is what we will get to next.
A certified nurse midwife (CNM) is licensed by the Medical Board of their state, the same board that licenses physicians. They are independent healthcare practitioners who specialize in out-of-hospital births. CNMs are licensed by the Board of Nursing and generally work in hospitals or birth centers, although some have home birth practices as well.
A certified professional midwife (CPM) is a midwife that holds an international credential in out-of-hospital birth. Typically they did a blend of clinicals and apprenticeships to become certified. They had specific guidelines to meet and had to pass a test at the end of their training.
There are also bachelor’s degrees for midwives such as a Bachelor’s in Science of Midwifery (BSM).
Again, please remember that every state is different. You need to find out for yourself the laws for your state. Are midwives regulated in that state? Are they required to uphold a license? Are home birth midwives legal there? Are certified professional midwives through NARM recognized? In some states such as Georgia and California home birth midwives are not ‘legal’ unless they are certified nurse midwives.
Next let’s talk things to know and questions to ask:
Once you’ve decided if home birth is right for you, you’ll begin your search for the perfect birth keeper for your family. Usually this is an extensive process. After all, you are trusting you and your child’s lives with this person.
-What are your credentials? How many years have you been a midwife? How many births have you attended? Are you licensed and/or certified? Have you ever had a complaint filed against you or had your license revoked?
-Why do you support out of hospital birth and why was becoming a midwife important to you?
-What are your fees and what all does that include? Also what are any added costs that we can expect to pay? Often birth kits and birth tub rentals are not included into the original fee. You want to ask about an travel fees too. I’m not near many midwives so I am paying a travel fee for being over 60 Miles away from them.
-Do you work with insurance companies? A lot of home birth midwives are not covered by insurance but a lot of insurance companies do cover the labs and ultrasounds.
-What happens if you have two births going on at once? What’s the plan of action?
-If you miss the birth or I risk out what happens in regards to the fee? Every midwife is different but the majority of them require you to pay in full by 36 weeks. If you risk out before that it is prorated to the prenatal visits that you had. After that, most do not refund you anything.
-Who accompanies you to the birth? In my case two midwives will be at my birth (Sarah Foster and Annabelle Demoss out of Tulsa, Ok/The Tulsa Birth Center) as well as a student midwife so three total on their personal birth team. I also booked doula who happens to be a friend. Her name is Chrissie Demarais so if you’re looking for a doula in this area, you can find her on Facebook. She is a great advocate for women and I’m excited to have her on my birth team. She will be there for all things labor support related and to record the birth for me. She’s encapsulating my placenta as well. Some midwives have doulas on their birth team or are doulas themselves and some even have photographers on their team. I hired my photographer separately. Her name is Cheyenne johnson and she’s out of Vinita, Ok. You can find her on Facebook and Instagram. Her work is to die for.
-What kind of equipment, medications, supplies, ect do you bring to the birth and are you certified in neonatal resuscitation?
-What issues risk me out of your care? Typical risk outs are early delivery, transverse fetal position, fetal heart rate fluctuations (sign of distress), hemorrhage, preeclampsia, ect. But definitely clarify those risks with your midwife.
-How do you handle emergencies? Mild and severe.
-What are the protocols for transfer during labor should something go wrong? You’ll want to have the hospital and insurance stuff in line as a back up for this reason. I’m lucky enough to have an established relationship with an OB near us. My husband’s big stipulation for home birth was that I continued to see my OB all the way up until the birth so that he has extra reassurance that baby and I are safe/low risk.
-How long do you stay after the birth and what are your post partum/newborn procedures? How do you insure that we are stable and how long do you require us to be stable before you leave?
-If I test positive for Group B Strep and opt to do the antibiotics during labor, how does that work? Do you administer them? Do you have a nurse that comes to do that? Is that included into my fees? As the mother it is our job to find out the states policies on this. Most midwives aren’t licensed to give IV medications. You will need a plan of action for this.
-Do you clean up the birth tub after the birth? I was surprised to learn that this wasn’t a given. Some midwives do not clean up after the birth. It is up to the family to do so.
-Can my children be present at the birth if that’s what i feel like doing in that moment?
-Can my spouse or child catch the baby? Can I deliver the baby myself?
-Can I do a herbal bath in the birth pool shortly post delivery?
-Can I deliver my placenta on my own time, naturally? Meaning it’s not forced/pushed out by me before i body expels it on it’s own.
Lastly I asked these questions just for hospitality’s sake:
-What kind of coffee, drinks, and snacks do you guys like?
-What can I do extra to accommodate your team in the event of a long labor?
I know that I’ll keep stock in snacks, drinks, bread, lunch meats, fruits, Ect because as a large family, I always do that anyways but my ‘plan’ is to put on a big crock pot meal such a stew, soup, chicken and dumplings, or roast if I have enough heads up (which has always been the case in the past).
I also keep plenty of clean throw blankets and extra pillows easily accessible full time so that’s a convenient birth team accommodation that we have. Not only is my birth team large (5 people excluding my husband) but my children, mother in law, and mom will most likely be present as well.
I hope that this post was helpful and if you are in the Arkansas, Oklahoma, Missouri, Kansas area and seeking a midwife please reach out to me. I’m happy to share my notes with you and maybe help narrow down your search. I can almost simply give you names and contact info for all of the midwives that I know of in our area.
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