In most cultures throughout history, women have given birth at home. The majority of women worldwide continue to birth their babies in non-hospital settings today. In many cultures birth is viewed as an integral part of family life. The advent of obstetrics in this century had a tremendous effect on childbirth customs in the United States. The birthing process became segregated from mainstream family life. Many were led to believe that the only safe birth was a hospital birth. Though doctors and hospitals took credit for statistics that indicated that birth was more successful than in previous centuries, in reality better nutrition, hygiene and disease control improved outcomes. Even today US statistics don’t support the premise that the only safe birth is a hospital birth. The US ranks 28th among industrialized nations for healthy births, at 7.0 infant deaths per 1000 births. (These data are based on 2002 statistics from the Maternal and Child Health Bureau: US Department of Health and Human Services.) Hospitals have never been proven a safe place to have a baby.

By the 1950s, most births in the US were taking place in hospitals. Cesareans, epidurals and heavy doses of pain medication became the norm. Women were denied feeling and experiencing birth through their bodies, and the drugs were having adverse effects on mothers and babies.

In the 1960s and ’70s, women began to question and challenge the way obstetricians were treating them—as though childbirth were a sickness. Women began to reclaim their power, and the homebirth movement was born.

The 1990s became a time of maternity awareness. People were concerned with making all of pregnancy and birth a family experience. Today, a carefully monitored homebirth has been proven to be very safe and successful for women who have been helped to stay low-risk through nutrition and good prenatal care. (See Johnson,K.C., and B.A. Daviss. 2005. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 330: 1416)

Midwives are the traditional care providers for mothers and infants. Midwives are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period. Midwives provide women with individualized care uniquely suited to their physical, mental, emotional, spiritual and cultural needs. Midwifery is a woman-centered empowering model of maternity care that is utilized in all of the countries of the world with the best maternal and infant outcomes such as The Netherlands, United Kingdom and Canada.

Midwives in the United States – There are approximately 15,000 practicing midwives in the United States.  Midwives may practice in private homes, clinics, birth centers, and hospitals. In most countries, midwives are primary health care providers and the central pillar in maternity care and women’s health care. However, slightly more than 10% of births in the U.S. are attended by midwives. Countries that utilize midwives as primary health care providers are also those countries in which mothers and infants fare best. The United States continues to rank behind most of the developed world in terms of infant and maternal mortality.

Midwives Foster Relationships with Women – Midwives value communication and developing a trusting, working relationship with the women and families they serve. In the course of developing that relationship, midwives provide personalized and thorough care at many levels: preconception, pregnancy, labor, birth, postpartum, and beyond. Many midwives provide primary health care, gynecological care, and care of the normal newborn. Some midwives prescribe medications including family planning and contraceptive methods. In addition to being trained to conduct comprehensive physical exams and order laboratory, screening and other diagnostic tests, midwives provide extensive health care education and counseling, as well as engage in shared decision-making with their clients and patients.

Certified Midwife (CM): 

A Certified Midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.

Certified Nurse-Midwife (CNM): 

A Certified Nurse-Midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.

Certified Professional Midwife (CPM): 

A Certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.

Direct-Entry Midwife (DEM): 

A direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, a college, or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings. Licensed Midwives (LM) and Registered Midwives (RM) are examples of direct-entry midwives.

Traditional Midwives: In addition, there are midwives who—for religious, personal, and philosophical reasons—choose not to become certified or licensed. Typically they are called traditional or community-based midwives. They believe that they are ultimately accountable to the communities they serve; or that midwifery is a social contract between the midwife and client/patient, and should not be legislated at all; or that women have a right to choose qualified care providers regardless of their legal status.

Compared to the average costs associated with either a vaginal birth of cesarean, a home birth is a small fraction of the cost for the amount and quality of the care received.  A recent report called “Cost of U.S. childbirth outrageous” by CNN estimates that the average cost of a birth by vaginal delivery is $18,329 and $27,866 for a cesarean.  Below is a rough estimate of the average time I spend with my clients:

Service Description	Hours
Prenatal Visits	12-14
Labor and Birth	2-48
Postpartum	2-6

Additionally, the pricing includes driving to your home for care services as well as being on call 24 hours a day, 365 days a year to answer any and all of your questions and concerns.

Every birth is a unique event and has a story and it’s my goal and passion to help make this an unforgettable, special experience for you to bring your bundle of joy into this world.

Women may plan a home birth because they:

• have had a previous positive birth experience in hospital, and now feel confident about birth at home,
• want continuity of care, with a midwife they know attending the birth,
• dislike being in hospital,
• are worried about the effect of a hospital environment on their labour,
• want to keep birth normal and avoid interventions,
• want to reduce the risk of infection,
• don’t want to be separated from older children,
• want more than one birth partner,
• want to avoid an overnight hospital stay without their partner,
• hope to use a birth pool  and cannot be sure that this will be possible in hospital,
• want privacy,
• want to feel more in control, or
• have had a previous negative experience in hospital, and don’t want to repeat this.

Ultimately, the decision to have your baby at home is yours but it always helps to have support and information in making that choice.

In deciding where to have your baby, you may find the results of the Birthplace Study 2011 helpful, as it provides detailed information about the four different places for planning birth. It compares planning to have a home birth with planning for a hospital birth, as well as comparing planning to use a ‘midwifery unit’ or birth center with planning a hospital birth.

The main focus of the study is outcomes for women who are ‘low risk’, i.e. those who are healthy, with a straightforward pregnancy and no previous obstetric complications that might affect this pregnancy.

While midwives are asked this question often, home births are typically not very messy.  In general,  incontinence pads may be used as well as a few towels.  For a candid narrative, please read “Home Birth Mess” by Amanda Topping, CPM.  Additionally, a UK home birth website contains a discussion circa 2008 by many patients called “Blood on the Carpet” with first hand stories.

It depends.  Some insurances do cover midwife and home birth services.  Other times, the services may be covered under a supplemental Health Savings Account (HSA) offered by employers.  It is best to check directly with your insurance company or benefits administrator to determine if the services are covered by them.  There are also specific medical billing services that specialize in billing for home birth and for a nominal fee will submit a comprehensive insurance claim to help recoup the costs.

Due to the quality and constant care of the Mother, a majority of home births never encounter an emergency; however, like any situation a myriad of events can occur where hospital care may be necessary.  As part of your care, we develop a comprehensive transfer plan and complete an emergency contact form.  Midwives are specially trained to deal with emergencies, having taken special care classes, such as:

Neonatal Resuscitation

Adult CPR

Birth Emergency Skills Training (B.E.S.T.)

Shoulder Dystocia Workshop