Q & A

Is home birth really a safe option?

This is a question that can only be answered by you. I believe it is safe for a low risk, healthy pregnancy but no birth is without risk. Even a hospital birth is not without risk. Most people that choose to birth at home have only chosen after extensive research and feel that the small risk of a serious complication is preferable to the high rate of intervention in a hospital setting (including the 33% national caesarean section rate.)

Why choose home birth?

Choosing home birth is a very personal decision. It is not common (less than 1% in the US) and many people will encounter resistance from family members and friends. People generally choose to birth at home because it feels more comfortable and they wish to avoid routine hospital interventions such as continuous electronic fetal monitoring or IV fluids. There are many reasons given, for example, I chose to birth at home because I desired a natural birth and wanted to avoid an unnecessary caesarean section. Others have stated that they view pregnancy and birth as a natural process not an illness and felt that the hospital was not the appropriate approach to childbirth.

What happens if something goes wrong?

I am trained to manage complications and transport as necessary. I do not take complications lightly and always strive for safety of mother and baby. This is a subject we should discuss in detail at your free consultation.

What happens if I want pain medication at a home birth?

I offer natural, non-drug alternatives along with love and encouragement. If this is not effective and you wish to have medication, we transport to the hospital. I accompany you to facilitate the transfer of care and support you in the hospital.

What happens in the event of hospital transport? Do you come with us?

Yes, in the case of transport I will accompany you and facilitate the transfer of care to the hospital by bringing your medical records and giving a verbal report to the receiving care providers. I stay with you until after the birth and take on the role of advocate and birth coach. It is important to help the you understand what is happening and help you get the information you need to make an informed decision.

How close do you need to be to a hospital?

There are no guidelines in place for this. It is more about what the birthing couple is comfortable with. I have heard of people, who live more than an hour away from a hospital, renting a place closer the hospital.

How much does a home birth cost? Do you accept insurance?

Home birth costs vary by region. Here in Monterey County the range is about $5-6,000 for prenatal care, delivery, and postpartum care. I do accept insurance and offer verification of benefits and billing service at no extra cost to you. However, there is no guarantee that insurance will cover care; it depends on your policy.

When is home birth not a good option?

Home birth is not a good option for a person with preexisting disease or condition making pregnancy and birth highrisk for them. Some examples are women with diabetes, certain types of heart conditions, thyroid problems or hypertension. In some instances, a pregnancy may begin as low-risk and a complication can develop such as preeclampsia. In those instances, the care of the woman must be transferred to an OB and home birth is no longer a good option. I can continue to work with you but the primary care is taken over by the OB and the birth will need to take place in the hospital.

Where did you get your training?

I am a Licensed Midwife/CPM and received my clinical training through the apprenticeship model and my didactic training from the National Midwifery Institute. I received my clinical training right here in Monterey County serving families like you.

What emergency procedures can you perform? What are you qualified or not qualified to do?

I am trained in CPR and Neonatal Resuscitation. I’m also trained to manage complications such as cord prolapse, breech, shoulder dystocia, hemorrhage, placental abruption, placenta previa and many others. I do not use forceps, vacuum extractor, perform surgical birth or perform external cephalic version (ECV is used to turn a baby from a breech to vertex presentation). I am qualified to attend the birth of a normal, low-risk pregnancy and manage complications. If a complication arises that cannot be dealt with at home, I will stabilize and initiate transport to the nearest hospital.

Who all attends the birth at a home birth?

I work with partner who is a Licensed Midwife and we work as a team to provide your care. Additional attendants are chosen by the birthing mother or couple.

What happens if two clients are in labor at the same time?

If two clients go into labor at the same time, we split up and call two other midwives to assist us. I strive to ensure each birthing mother is attended by at least one midwife she knows, this is called continuity of care. In addition, I limit the number of primary clients I will accept to around 4 per month.

Can I still have a doula attend my birth?

Yes, a doula is a wonderful addition to a home birth. However, many home birth couples do not choose to hire a doula, probably due to extra out-of-pocket expense. I usually arrive when the mother moves into active labor; however, I will try to come as soon as the mother wants me there. I have had couples that hired a doula to be there in early labor and then called me when they reached active labor. There are doulas in the area that offer discounts to home birth parents, ask me for more information.

How long do you stay at my house during the birth?

I generally arrive around the onset of active labor or sooner if you wish. I will stay until mother and baby are stabilized following the birth, usually between 2 to 4 hours after the birth. I will stay longer if there is a complication or if mother or baby are not quite stable.

What do you bring to labor? What do I have to provide?

You will have to provide some basic supplies, often referred to as a “birth kit”. Some examples of what you might find in a “birth kit” are: under-pads, peri-bottles, gloves, maternity pads, sitz bath supplies, bulb syringe to suction baby, etc. If you want a water birth and do not have an appropriately sized tub in your home, you will have to rent or buy a birthing pool. I bring items like a Doppler to monitor the baby’s heart, oxygen and equipment to help the baby if they have trouble breathing, drugs to control hemorrhage, sutures and lidocaine to repair a laceration, instruments to use to cut the cord or repair the perineum, IV supplies, and many other things that might be needed.

Do you come to my home for prenatal and postpartum visits?

Prenatal appointments are done in your home or my home office. If the appointments are conducted in the office there will be at least one home visit. The postpartum visits are generally done at home. For example, I would do the first 3 postpartum visits at home (24 hour, 3 day, 7-10 day) and usually the 6 week check up is in the office.

How does prenatal and postpartum care differ from care with an OB/GYN?

You will spend much more time with me during your prenatal care than with an OB. I generally spend an hour with you at each prenatal visit. During visits we will do the same things such as test urine, take your blood pressure, listen to the baby’s heart, screen for abnormal symptoms, measure the fundal height, etc.

Later in the pregnancy, I will spend time palpating to determine the position of the baby. It’s my understanding that most OBs do not palpate during a prenatal visit. In addition, we will spend the majority of the visit discussing general health, diet, exercise, pregnancy, including psycho-social issues. I do my very best to make sure that my clients get all their questions answered at each and every visit.

Another big difference is that I spend time discussing all diagnostic testing with you. It’s important that you understand what the test is for and can decide if you want the test or wish to decline. Postpartum care is a minimum of 4 visits, 3 home visits (1 day, 3 days and 7-10 days postpartum) and a 6 week office visit. Additional visits are available upon request and encouraged, including visits just for breastfeeding support.

Do I still need to see an OB/GYN at all during my pregnancy?

It is not necessary to see an OB during your pregnancy, as I am the primary care provider for your low-risk pregnancy. If a serious complication arises during prenatal care, I will consult and/or refer you to an OB. Most clients do not continue or seek care with an OB once they have hired a midwife. However, I am not opposed to co-care with an OB and believe that you should have whatever type of care you desire.

There are multiple midwives in the area. How do I go about choosing which one to use?

You should interview them and see with whom you feel most comfortable. A home birth is a very intimate event and you will be spending many hours with your midwife during prenatal visits, the birth, and postpartum visits. Many midwives offer similar services and have similar philosophies but we do differ, ask lots of questions and choose someone you think you can work well with as a team. Ultimately, you should really like your midwife; it’s a very different relationship than you may be used to having with other healthcare providers.