Common Questions about Homebirth and Midwifery Care

15734927444_b9d6b6a789_o.jpg

Am I a good candidate for a homebirth?  Who is considered "high risk?"

Most people who are good candidates for homebirth:

  • Are in good physical and mental health
  • Have good nutritional status
  • Have adequate social support before, during and after birth
  • Are socially mature and able to accept responsibility to make informed choices throughout their pregnancies and for their birth outcome.
  • Have a positive emotional environment
  • Have access to childbirth, home birth and breastfeeding education such as books and classes.
  • Understand that technological intervention is used only when necessary.
  • Understand that pain medication will not be used during labor.
  • Agree to respect the midwife's clinical judgment to  transfer to the hospital prenatally or during labor, birth or postpartum, if necessary

You may not be a good candidate if you:

  • Are Rh-negative and have become sensitized to Rh-positive antigens
  • Have high blood pressure
  • Have pre-existing diabetes (this is different from gestational diabetes) or gestational diabetes not controlled by diet
  • Have heart, kidney or lung disease
  • Have certain types of clotting disorders 
  • Have placenta previa

If you have a question about whether you are a good candidate for a home birth,  get in touch!

 

What equipment do you bring to the birth?

Among many other things, I provide

  • sterile instruments for the birth and afterward
  • a doppler for listening to the baby's heart rate during labor and pushing
  • an oxygen tank and resuscitation bag/ masks for mother and newborn
  • a suction device for removing mucus and other material from the baby's nose and mouth
  • drugs for preventing or stopping the mother from bleeding too much after the birth
  • IV equipment and fluids for rehydration of the mother
  • Herbal and homeopathic remedies for use during labor
  • Antibiotics for GBS positive mothers 

Clients are required to purchase certain other supplies for the birth, such as disposable underpads and gloves.  You can take a look at my birth kit here.  

 

What happens in an emergency?

My job during your labor is to hold space for things to unfold safely. Part of that holding of space is monitoring for signs that tell me labor has gone outside of what is normal. The majority of problems that occur during labor and birth present warning signs and midwives  are extensively trained in recognizing these warning signs.  In addition, my experience working in a "high risk" setting has given me a lot of experience in this regard!

Sometimes, just a change in the mother's position or rehydration solves the problem and a hospital transfer is not necessary.  But by far, the most common reason for going to the hospital during labor is not an emergency but maternal exhaustion and/or request for pain relief (this is more common in first-time mothers with very long labors).  Occasionally, we may transfer for a cervix that stops dilating or because the baby's heartbeat is indicating they are stressed for some reason.  Even more infrequently there are circumstances that are more emergent, such as sudden, severe changes in the baby’s heart rate, sudden onset of unusual bleeding in labor suggesting a problem with the placenta, or a severe postpartum hemorrhage requiring a blood transfusion.

It must also be acknowledged that birth is only as safe as life gets, and extremely rare events can occur that present no warning signs. An example of this would be a clot (embolism) in the mother’s lungs or a placental abruption. These extremely rare events are life-threatening no matter where they occur, but a hospital would have more equipment and a larger number of trained health care personnel immediately available to respond than would be possible at home.  But because these events are sudden and  immediately life-threatening, there is sometimes nothing that can be successfully done to protect the mother or baby even in a hospital setting. That being said, it is important for families considering home birth to be willing to accept these risks.

 

Do you support waterbirth?

I love waterbirths!  Many homebirth clients choose to labor or give birth in the water.  I use a waterproof doppler so I can still monitor the baby's heartbeat regularly if you choose to labor in a tub or shower.  If you choose to give birth in the water, I will help you to bring your baby up out of the water and gently into your arms within a few seconds after they comes out.  You baby is able to receive all of their oxygen through the umbilical cord, just like they do throughout the entire pregnancy, for these few seconds.  If you are curious about the evidence surrounding Waterbirth, Evidence Based Birth (a great resource!) has an entire article devoted to it here.

 

When should I initiate care?  

What if I have been seeing another provider?

Some people may know from the start of their pregnancy that they want to give birth at home, and others may decide at some point during the pregnancy.   You can begin your care with me, or transfer somewhere along the way.  As long as I have availability and we are a good fit, I do accept "late" transfers.  It is normally quite easy to get your records from a prior provider if you are transferring care.

 

This is my first pregnancy.  Can I have a homebirth?

Yes!

 

Do you require i hire a doula?

I do not "require" anyone hire a doula.  That being said, I very much encourage and support the decision to hire one and think it's especially important if this will be your first experience laboring.  Take a look on my resource page to see a list of doulas I recommend.

 

How do I know if we are a good fit to work together?

I provide a free consultation visit so you can get to know a little bit more about me and to ask questions to help you decide whether a homebirth is right for you.  Please get in touch -- I'd love to meet you!

 

Do you take insurance?

Like all of the homebirth midwives in NYC, I am not in-network with any insurance.  However, I have an excellent, dedicated staff member to help you navigate getting the best possible coverage from your specific plan, oftentimes even when your plan has no out-of-network benefits.  Your insurance may cover all of the prenatal, birth, and postpartum care, or you may be responsible for some balance -- but our goal is always to have insurance pay first, not you.  In this process it's important to consider that many of us budget for the life events and experiences that are important to us, such as weddings and vacations, and that there are few life experiences that have the potential to be quite as impactful, long-term, as birth.

That all being said, making homebirth accessible to all is a deep value and priority for me.  I am committed to finding ways to work with low-risk individuals from all socio-economic backgrounds.   Let's find a way to make it work!

Every midwife knows
that not until a mother’s womb
softens from the pain of labour
will a way unfold
and the infant find that opening to be born.

Oh friend!
There is treasure in your heart,
it is heavy with child.

Listen.
All the awakened ones,
like trusted midwives are saying,
’welcome this pain.’

It opens the dark passage of Grace.
— Rumi