6 Things to Know About Home Birth, According to a Midwife

From the moment you get pregnant, you start to visualize how your birth might unfold and make plans for welcoming your baby into the world. You have many options to consider- everything from how you plan to give birth (IE. in a tub, with music, surrounded by candles) to where you want to deliver (IE. hospital, birth center, or home).

But before you make your decision about the location of your birth, we went straight to the source-Licensed Midwife and Lactation Consultant Sara Howard-to elaborate on a few things every mom should know about home birth.

Do your homework about your place of birth.
Most Americans think that the hospital is the safest place to give birth. Why wouldn’t you? That’s how it’s done in the movies, and in our culture. When I ask people how they think the US ranks when it comes to maternal mortality in the developed world, they usually say something like, “Oh, I don’t know. Somewhere in the middle?” Nope.

As compared to all the other nations in this category, the US is doing the WORST when it comes to keeping birthing people healthy and alive. Check it out for yourself. I always tell pregnant folks that when it comes to choosing where to birth, it pays to look at what other countries are doing. In places like the Netherlands, virtually all low-risk pregnant people start in the care of midwives, and they only graduate into obstetrical care if they become a higher risk.

Similarly, in countries that are doing far better than us, folks have the option of where to give birth-home, birth center, hospital. And nobody has to pay out of pocket. That’s because there is evidence that supports the fact that if you are low risk, it is best for you to start out of the hospital in the care of midwives. 

This practice reduces your risk of unnecessary interventions, which increase your risk of complications. You would do your homework on which school to send your kid to, right? Dig into this issue a bit, because it’s worth it.

Find the provider for YOU.
When choosing who to birth with (inside or outside of the hospital), I think your gut instincts are key. Interview providers-doctors or midwives- shop around! We all approach pregnancy and birth a little bit differently, and don’t ignore the personality piece. Is this someone you can see sitting next to you during some of your most intimate moments? Does his/her voice annoy you? Because that just isn’t going to work!

And ask good questions-where did they train, how long have they been practicing, how many births have they done, how do they prepare for complications, and if birthing at home, then add what is their transport plan in case you become higher risk and need the hospital. And don’t forget philosophy! We all bring our intersectional identities and beliefs to the table. Find the provider that is best for YOU. You deserve it, and the relationship and trust you build will make for a smoother, easier experience.

Make a good plan, and then let it go.
A mistake I think we often make in home birth is ignoring the possibility of a hospital transport. Often, we fight even the idea that we might have to pack up our stuff and head into the place we were trying to avoid. But by not facing that possibility, do we taunt it? Entice it?

In Los Angeles where I practice, approximately 10% of all home birth clients will transport to the hospital for non-emergent interventions. Those scenarios typically look like long labors that have completely depleted and exhausted a laboring person, and they need to recharge. Sometimes, the best way to do that is to get some pain relief and go to sleep-then you and your uterus can regain the energy to finish your birth. Pretty simple, and not much drama.

It’s my opinion that talking with your provider about what transport could look like, and having a solid plan about where you’ll go, can actually take some pressure off (like letting a little steam out of a pot about to boil).

A couple tips for your hospital imagining:
1. Keep in mind that overall, we have systemic problems in the US maternity system, but by and large, the people working in the system are good. Overall, they want the best for you and work hard every day to keep folks safe the best way they know how. So, start by giving the people the benefit of the doubt. The nurses, doctors and staff that you meet can be your greatest allies, so try not to start out on the defensive.

2. That doesn’t mean you can’t advocate for yourself. Asking good questions and saying things like, “I’d love to have five minutes to talk with my partner about that” is always a good idea. You don’t lose all control of your birth simply because the location changed. It’s your body and it’s your baby’s birthday!

Hire a doula.
Many people ask me why I recommend that they hire a doula when they have a midwife. The reason is because we do two totally different jobs. Your midwife is charged with the health and safety of you and your baby and ensuring that your labor remains low risk. We take your vital signs and listen to your baby’s heartbeat to make sure that your baby is coping well with contractions.

In California, we’re licensed to carry medications to stop bleeding; we bring an oxygen tank and we run IVs; and we suture you if needed after the birth. And while we monitor your emotional and psychological health in the process (it is just as at play during your labor as your blood pressure), our primary focus remains ensuring that you and your baby are safe.

Your doula is charged with your comfort, your stamina, and your partner (among many other things). They have toolkits full of pain reduction techniques and suggestions, for both before, during, and after and they give your partner the option of taking a break for a sandwich, a snooze, or a walk around the block (they don’t get the endorphins you get during labor!). When working seamlessly, the midwife and doula team provides safety and options, medical monitoring and massages, skills and tricks to help a laboring person and their partner find every ounce of strength they have to get through to the end. A doula will also be able to help you with those first few months as parents, even if this isn’t your first time becoming parents. Doulas are magical.

Home birth isn’t as messy as you think.
I once had a partner ask me if in preparation for their home birth, if he should cover the apartment wall to wall in tarp. I stifled a giggle and assured him that the labor and birth weren’t going to be like an episode of Dexter!

Truly, home birth is far less messy than you might imagine. Your midwife will have you order a small kit of materials that comes to the house and it includes things like plastic to put under your sheets to protect your mattress from fluid; blue “chux” pads-which are disposable pads (much like puppy pads) – that your midwife will keep underneath you; and maxi pads for after the birth (after you have a baby you bleed similar to a period). 

When dealing with home birth tubs, I’ve been asked if they’ll have to be filled and emptied with buckets, and could the weight of it break through an apartment floor? Well, a birth tub holds about 150 gallons of water, and at about 8.3 lbs per gallon, that’s about 1245 lbs (via Google). The most recently elevator I rode in could carry 2200 lbs, so your apartment floor should be just fine! And no, we don’t use buckets (that would take forever!). Water is pumped into the birth tub via a portable water hose attached to your sink or shower and pumped out with a submergible sump pump that empties into your toilet via a hose (automatically triggering your toilet to flush as the water drains).

When your birth team leaves after your birth, you’ll typically be left with a house that looks exactly as it did when they arrived, except for the addition of a new baby, one bag of trash, and one bag of laundry.

This is just the beginning, but it matters.
Too often, I hear people say things like this to people who are having their first baby and planning to birth at home, “You have no idea what you’re in for, the birth is just the beginning.” Maybe they say that because they don’t like where you’ve chosen to give birth, or they’re feeling defensive about a choice that they made. And on one level, they’re right.

Your labor and birth are just the beginning of your parenting journey (as is your pregnancy). And in my opinion and practice, we do keep the big picture in mind. Not all babies should be born at home, and sometimes folks become higher risk and need to change their place of birth. But, what never changes is my emphasis on two things-no matter where you give birth, you have the right to be respected and heard, and you don’t have to end up traumatized.

How your birth goes does matter. There is evidence that trauma during birth can have long term impact, including increasing your risk of postpartum depression. That’s why each of the above points are essential. Choose your place of birth and your team wisely, and then do your best to let all your expectations go.

No matter what happens, you’re a parent now. And it’s the best thing in the world.

Sara is a Licensed Midwife (LM), Certified Professional Midwife (CPM), and International Board Certified Lactation Consultant (IBCLC). She has a BA from Beloit College in Wisconsin, and graduated from the National College of Midwifery. She attended UC San Diego’s lactation consultant program. Sara has a background in healthcare advocacy, and worked for nonprofit organizations in Los Angeles for ten years before becoming a midwife. She married her wife in 2011, and together they welcomed their twins in 2014. Sara founded her private practice, Horizon Midwifery, to support all individuals and families as they explore their healthcare options and expand their families. She takes great joy in being part of people’s road to health and parenthood.

Opening Image: Vanessa Tierney for Mini Magazine, Story Images: Courtesy Sara Howard