Is it safe to have a homebirth?

http://www.storknet.com/cubbies/homebirth/homebirthsafety.htm

http://www.parentsplace.com/expert/birthguru/articles/0,,243383_533478,00.html

http://www.gentlebirth.org/ronnie/homejjg.html

What can I expect during pregnancy?

Prenatal visits may take place at the midwife's home or clinic or at the family's home. The latter is especially comforting for the family, as they are in their own surroundings and may be less hesitant to ask questions and get involved. Prenatal visits are also a time for the midwife to get to know the family and friends, neighbors, or other children who plan to be present at the birth.

Prenatal care for the pregnant woman includes discussion of nutrition, exercise and overall physical and emotional well-being, as well as overseeing the healthy development of the fetus.

Midwives include the family during prenatal care, inviting them to ask questions and to listen to the baby's heartbeat. Intimate involvement of the family throughout the pregnancy allows for early bonding of the newly emerging family unit.

The midwife and family will often discuss the mechanics of birth. The more people know what's going to happen, the more comfortable they may be while awaiting the birth.

The midwife interviews the pregnant woman to determine if a high-risk situation exists (homebirth may not be a viable option for everyone). A high-risk woman has certain medical conditions or special needs. She may have diabetes or blood disorders. VBACs have slightly increased risks, but do not rule women out from having homebirths.

If they do determine that a high-risk situation exists or may develop, the midwife and family decide whether a homebirth is practical. This process is especially important for those families in rural areas many miles from a hospital. As midwives have varying levels of experience, some are more comfortable than others in handling situations with higher risk.

During this time the midwife helps the family to prepare for the birth.

The family may want to have a birth plan. This includes a list of what will occur during the birth: special music, candles, special religious or cultural rituals, who will be in attendance, which room in the home will be the birthing room, what kind of support the mom desires, etc. These steps enable the family to create the atmosphere they want.

Birth is a well-designed process, and most women can give birth easily by trusting in themselves and in their birth assistant.

What can I expect during labor?

When the mother's labor begins, she calls the midwife. The midwife may be intimately involved right from the beginning of labor or may be there in more of a peripheral sense. She is there to serve the family. At homebirths, family and friends frequently join together in support of the birthing family. Husbands or partners may be very important to the birthing mom during this time. The midwife can help fill the primary support role if other support is not available to a single mom.

Usually someone other than the mom or her partner assumes responsibility for any children who are present, freeing mom to focus on birthing. Another adult may be the designated photographer.

The midwife helps to calm people who are present at the birth. Tension in a room can slow down or stop a labor. The midwife handles these situations so that the mom and her partner can continue to focus on the birthing process.

Because homebirth families are well prepared, the birthing process can feel quite natural. They can let go of any fear surrounding birth and trust the process instead. If difficulties occur along the way, they are calmly resolved.

During labor the partner and family nurture the mom. The midwife is watchful for any complications or signs of distress in either the mom or baby. Throughout labor, the midwife asks permission to perform any procedure and explains to the mom and family what she is doing and why. Of course them mother always has the right to deny any procedure.

The birthing process is allowed to take its own course and set its own pace. The general philosophy is that any interventions (administering drugs or trying to hurry things along) create more harm than good.

In the safety and security of her own home, the mom is likely to be less inhibited about trying different labor positions and locations. She can sit on the toilet or go for a walk outside. She can eat or drink whatever she wants. She writes her own script. When it's time to deliver, she can often try whatever position she wants: on her side, squatting, sitting or kneeling.

What can I expect during the birth?

Homebirth allows for full participation of family members. Under the guidance and assistance of the midwife, the opportunity is available for husbands, partners or older siblings to "catch" the baby as it is born. These moments can be very powerful and transformational in the lives of the new parents.

At homebirths, babies are usually immediately placed on the mom's stomach or breast, providing security, warmth and immediate bonding between mom and baby. This contact provides security for both mom and baby.

In the rare case when the baby has difficulty breathing on its own, midwives are fully trained in infant CPR. Usually, putting the baby right to the breast and having mom talk to her baby will encourage it to take those first breaths.

Putting the baby immediately to the breast helps reduce any bleeding the mom may have. The sucking action stimulates the uterus and causes it to contract. This closes off blood vessels and reduces bleeding.

After a hospital birth, things can get very busy, with bright lights and so many people doing things to the baby. This can cause a baby to shut down or shy away from people. At home there is an opportunity for everyone to relax. There's time to be quiet, calm and peaceful.

Those first moments are a sacred time, a time to be honored. This is baby's special bonding time with its parents and all the family and friends present. When a baby is born, all that baby wants is to be loved and taken care of. This early bonding allows the baby to relax and feel secure. The mother's milk supply usually comes on the third or fourth day after birth. Prior to that, the baby is drinking a substance called colostrum, which has many antibodies to help fight bacteria and build up the baby's immune system. It is also rich in vitamins and protein. The midwife will offer counseling and support in getting started and continuing to successfully breastfeed.

Some members of the medical community have recently acknowledged that having a homebirth decreases the mother's and baby's chances of contracting an infection. The mother is used to the bacteria in her own environment and has built up immunities to it. This is passed on to the baby through the colostrum. Even when women are segregated in maternity wards, infections are much more commonplace after hospital births than homebirths.

One of the benefits of homebirth is that after the birth and special bonding time, mom and baby can be tucked into their own bed in the comfort of their home to rest and sleep. The husband or partner sometimes joins them for rest and deeper bonding.

After the baby is born, the midwife doesn't go away. She is still accessible for information and support. This can be of great comfort during the postpartum period when moms have questions or problems. The midwife will continue to check in on the mother, baby and family for a usual time frame of eight weeks, although some midwives will continue to get calls for a much longer time. Some families and midwives form lasting friendships based on the joy and trust they shared at birth.

What happens during the postpartum period?

With all the talk about pregnancy and birth, often times we forget to mention the postpartum phase. As a rule midwives usually see their clients two to five times after the birth. Most doctors only see their patients once after the birth at the six weeks check up. Your midwife is available by phone and many use e-mail too. You can look towards your midwife for breastfeeding support and referrals to breastfeeding friendly pediatricians. Your midwife may also serve double duty as a postpartum doula; someone who mothers the mother after birth, by shopping, light cleaning and offering emotional support.

Why should I choose to have a homebirth?

In most cultures throughout history, women have given birth at home. Currently, the majority of women around the world continue to birth their babies in non-hospital settings. This is partly due to culture and a desire to be in a familiar, safe environment. In many areas 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 their hospitals took credit for statistics that were better than statistics of previous centuries, in reality it was better nutrition, hygiene and disease control that improved outcomes. Sadly, even today U.S. statistics don't support the premise that the only safe birth is a hospital birth. The United States ranked 18th among industrialized nations for healthy births, at 10.7 infant deaths per 1,000 births in the early 1980s. (Data is based upon 1984 statistics from the United Nations Statistical Office.) Our current rank is even lower, around 22nd among other nations. Hospitals have never been proven a safe place to have a baby.

By the 1950s, most births in the United States were taking place in hospitals. Cesarean sections, 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 '70's, women began to question and challenge the way obstetricians were treating them -- as if childbirth were a sickness. Women began to reclaim their power, and the homebirth movement was born.

The 1990s became a time of maternity awareness, a time when people were concerned with making the entire pregnancy and birth experience a family experience. Today, a carefully monitored homebirth, with women who have been helped to stay low-risk through nutrition and good prenatal care, has been proven to be very safe and successful.

The most important factor in choosing homebirth is that the mom have a strong desire to birth at home. Even though a homebirth can save money, cost is not sufficient motivation to birth at home.

The most successful homebirthers are those who have a strong commitment to it and who trust in their body's natural ability to birth. They are often willing to devote time and energy to finding the right birth assistant, to doing their own research and to taking care of themselves.

For some mothers, the comfort of home and familiar surroundings can be very supportive and promote an easy birth. Others may feel uneasy that more technical medical assistance isn't at hand. But with a skilled midwife and a non-meddlesome approach, homebirth is safer.

Families who choose homebirth may be confronted by family and friends who, conditioned by a society afraid of out-of-hospital births, may challenge their decision, feeling it is both unwise and unsafe. Again, a strong inner commitment is required to stand up for the right to birth as they choose. Showing family members the evidence is sometimes helpful.

http://www.homebirth-only.com/WhyChooseAHomebirth.htm

Why choose a Traditional Lay Midwife (TM)?

This is a woman who has apprenticed with an experienced midwife or is self taught by assisting women during childbirth and may have attended additional workshops and classes to supplement her education or she may have attended a school. Her focus is on homebirth or birth center births. She may be affiliated with a physician, but she is not under the physician's directive. She chooses not to be certified to not be regulated by modern politics or obstetrical practices. A TM doesn't use preform obstetrical procedures or use its tools.

Because of a TM’s education and path into midwifery, she is best suited for assisting at homebirths. A TM is dedicated to helping a woman achieve a safe and natural pregnancy, which is free of interventions, invasive exams, multiple tests, time constraints and the personal agenda of the persons assisting at the birth. She wants you to be educated about your body, childbirth and breastfeeding. She wants you to take responsibility for your prenatal and postnatal care.

A TM is more than a ‘trained professional’ assisting you with your birth; she is a friend who believes in you, your body, your child and Mother Nature. If you are seeking a person you can trust, talk to and confide in and you are looking into choosing a TM, you are looking in the right place. A TM aims at empowering women so that they find the midwife inside of them and will choose to have a FreeBirth, even if this means not having their midwife attend their birth.

Midwife means "with woman." Traditionally, women have attended and assisted other women during labor and birth. As modern medicine emerged in the West, birth fell into the realm of the medical. Since women were barred from attending medical schools, men became the birth practitioners. Having never had a baby themselves, they were unable to approach women and childbirth with the inner knowledge and experience of a woman. Childbirth became viewed as pathological rather than natural; unnecessary, and often dangerous or unproven, medical techniques and interventions became commonplace.

During the 1960s and 1970s, along with the women's movement and renewed interest in homebirth, the midwifery movement rekindled. It has been growing steadily ever since. Midwives are becoming more and more involved with birthing families and have been instrumental in redefining birth as a natural event in women's lives.

Midwifery empowers women and their families with the experience of birth. Most midwives honor whatever constitutes a family for individuals, whether it be heterosexual or homosexual couples, single mothers, or any other group of people.

Are homebirth and midwifery covered through my insurance?

Each insurance policy is designed with different needs in mind. Read your particular policy and look for specific terminology. Does it allow for a Licensed Midwife? a Certified Nurse-Midwife? no midwives, an OB or OB Specialist only? Does it mention homebirth by name? It's usually recommended that you call your company and ask them exactly what they will cover before making a decision about your care provider. Sometimes, paying out-of-pocket is the only way to have a home birth. By doing your "homework" with the insurance company and during the selection of your care provider, you will be able to ensure having your birth your way.

Even if your insurance company does not cover homebirth, you should still file with them for reimbursement. This lets them know that there is a demand for such services. Your midwife should be able to assist you in filing for reimbursement, if not ask your HR department or call the insurance company to find out what forms you need to file.

What are the costs involved with a homebirth?

The average ‘natural’ hospital birth costs from $5000 to $15,000, depending on where you live and what your doctor thinks s/he is worth. A birth at a birth center can cost $3000 to $10,000, again depending on location and what type of provider you are using. The typical homebirth will cost about $1800, but can range from only $900 to $3500.

Are there any special supplies I need to purchase for a homebirth?

First and foremost, if there is anything you specifically want to have on hand, buy it. For instance, music, videos, film, aromatherapy scents, candles etc. But, most items your midwife will provide or she will give you a list of items you are responsible in purchasing. Below is a basic list of things you might want on hand regardless of what your midwife brings.

• Small bottle of almond, olive or other natural massage-type oil. (For lubrication of any body part, if desired)
• Underpaddings. Large plastic drop cloths, shower curtains or even trash bags to protect surfaces, covered in old towels, sheets or blankets that can be washed (or thrown away). Some women prefer disposable "chux" pads; they can be purchased in the adult diapering section of your local shop.
• A copy of the book Emergency Childbirth: A Manual by Dr. Gregory White
• Some people like to have a Stethoscope and/or Fetoscope
• A camera or video recorder (with film)
• A pen and paper to jot down times and anything of interest
• Foods, drinks, teas or tonics for the laboring mama and her support team
• Videos, toys, art supplies, puzzles, etc. for anxious siblings to discover
• Warm towels, blankets, receiving blankets or robes. Some families put towels in a dryer, on a heater, folded around a warm heating pad or in a barely warm oven during labor so they'll be cozy after birth.
• A large pan, bowl or bucket for catching the placenta (those ice cream buckets work well).
• Maxi pads (cloth ones or even towels work well)
• Arnica 30C for bruising or pain (mama and perhaps even baby)
• Pain reliever for after-pains (herbal tinctures, teas or commercial)
• Diapers and baby clothes
• Celebratory foods, drinks or items for baby's very first Birth-day party

What are my responsibilities when choosing a homebirth?

1. The pregnant woman is responsible for learning about the physical, psychological and emotional process of labor, birth and postpartum recovery.
2. The pregnant woman is responsible for learning about good antenatal and birth care so that she may choose the best possible arrangements which suit her individuality and circumstances.
3. The pregnant woman is responsible for learning about her practitioner's methods including evaluation of statistics or past cases and talking with other clients.
4. The pregnant woman is responsible for her own emotional and physical well being during pregnancy.
5. The pregnant woman is responsible for attending her antenatal appointments and informing her practitioner if she is unable to attend.
6. The pregnant woman is responsible for her own psychological preparation for homebirth in a society which may be unsupportive or even hostile, especially if the pregnancy results in the death of a baby.
7. The pregnant woman is responsible for meeting her practitioner's requirements for preparation for homebirth.
8. The pregnant woman is responsible for informing the practitioner of any relevant physical, emotional or psychological information which may affect the outcome of her birth. These may include intake of drugs, medications, herbs, allopathic, naturopathic, psychological or alternative therapies and the obstetrical, sexual or psychological history of herself or her relations, friends or partners which are affecting her attitude towards birth and parenting.
9. The pregnant woman is responsible for providing a suitable birth pace and environment for her newborn baby.
10. The pregnant woman is responsible for making any alternative arrangements for her birth and for booking into hospital.
11. The pregnant woman is responsible for making mutually agreed upon birth plans with her practitioner in advance of labor
12. The pregnant woman is responsible for choosing a suitable support person or persons for her birth and for ensuring they are emotionally and psychologically prepared for their role at her birth.
13. The pregnant woman is responsible for being assertive enough to dispense with any person who is not supporting her during her labor
14. The pregnant woman is responsible for ensuring her support people can carry out her preferences if she is unable to express them during her labor
15. The pregnant woman is responsible for the psychological and emotional preparation of siblings for the birth.
16. The pregnant woman is responsible for the choosing and preparation of individual support people for siblings.
17. The pregnant woman is responsible for acquiring information about breastfeeding and care of the newborn.
18. The pregnant woman is responsible for arranging domestic support for herself and her family during the postnatal period.
19. The pregnant woman is responsible for obtaining information regarding the cost of her care and making arrangements for payment.
20. The pregnant woman is responsible for evaluating the quality of care she has received and making any dissatisfactions she may feel known to her practitioner.

What are the legal aspects of homebirth and midwifery?

For legal aspects concerning homebirth and midwifery in Pennsylvania click here.

What if I have a complication during pregnancy or birth?

Occasionally, there will be complications during labor. The midwife can recognize the early stages of complications and to take necessary action. Transport to the hospital during the course of the birthing process may be necessary for the health of either the mother or baby. To promote a smooth transition in this situation, some midwives have their pregnant moms pre-register at a nearby hospital.

The rate of cesarean deliveries is very low for midwives and homebirths compared with hospital births. Part of the reason for this low rate is the fact that most homebirths are kept low risk by good care. Furthermore, midwives aren't in a hurry. They want to take time with their families. They generally don't hurry the birth either, which, ironically, often speeds it up. When a midwife and mother build a personal relationship, this trust helps women let go and have their babies more easily. Labor and childbirth are a natural process, and unless distress to the mother or baby is indicated, this process is not interfered with through drugs, medical equipment or cesarean intervention.