So you want a home birth, but you want to know how they’re going to clean up all of that blood and uh, stuff? In the hospital it just fell into a neat little plastic bag at the end of the bed, and was promptly whisked away after delivery right? How will they do that at home? Does my husband have to clean it all up? And after all that, who pays for it?!
Well, I have some thoughts on the matter. Here you go my A to your frequently asked Q’s. I sure hope this clears up some of those questions (here’s a hint: Chux pads!)
1. Is home birth safe? – I hate confirming stereotypes about home birth, but it really is the most frequently asked question! Do you ask your OB if hospital birth is safe? That’s not a bad idea. Hospital interventions are associated with all kinds of risk and adverse outcome. Take for example the latest findings that induced labor increased the risk of autism by a whopping 23%! Cesarean sections increase maternal mortality by six times over vaginal birth. Cesarean sections have also been associated with infection, hysterectomy, subsequent complications of pregnancy, infertility, and still birth. But we rarely ask if C-sections are safe.
“Birth is as safe as life gets” said birth photographer Harriette Hartigan. It’s true. Most of the time life is well, safe. We get in our cars, hop on planes, swim in oceans, and we’re fine. Very occasionally, there’s an accident, a failed landing or a shark attack, and that makes the news. Birth, in the context of a well nourished, healthy woman, is incredibly safe. It is even more safe when attended by an experienced and trained midwife. In study after study (after study), midwives delivering out of hospital have similar rates of adverse perinatal outcomes as those found with a similar population in the hospital. In addition, midwives have lower rates of intervention, inductions, episiotomies, and Cesarean sections than practitioners who deliver in hospital. My private practice’s Cesarean rate last year was less than 5%.
Birth becomes risky when we intervene in a natural physiological process. The natural, and hormonal needs of birth require privacy, warmth, intimacy and trust. If we left well enough alone, birth would unfold as easily as a cloud releases rain. Home birth by its nature, with no anesthesiologist, no cold rooms and bright lights, no strangers, is the perfect stage for a safe and healthy birth for mom and baby.
2. What about the mess?! How about the placenta?! A smoothie anyone? Mess is such a non-issue. I ask my clients to have some hydrogen peroxide on hand, and plenty of chux pads. The combination is all you need to keep surfaces clean and dry. While the new family is nuzzling and cooing, I usually grab the bottle of hydrogen peroxide and some towels, and go on a search and destroy mission. There may be an occasional drop of blood or two, but they always come out.
Before my assistant and I leave, we make sure the place is neat and tidy. A load of laundry is started, dishes washed, and the trash is taken out. You would never know we were there, if not for maybe the birth tub, and the bundle of cuteness in your bed!
Placentas can be frozen, eaten, buried, encapsulated, or yes, tossed. It’s a personal preference. I just ask that you have two quart size freezer bags for me to store it in. It’s that easy.
3. How do you get paid? Will my insurance cover it? Why thanks for asking! Some insurances do cover home birth. Namely PPO’s. HMO’s, Kaiser, and MediCaid in some states, do not cover out of hospital birth. Although, it’s not always so clear cut. Sometimes, when you need a service that your insurance can’t provide you an get a GAP exception and they will cover the service, even if the provider isn’t in network for your insurance company. There are some billing companies that cater to midwives and through whom parents can pay $20 and have them verify your insurance benefits. I highly advise this as they are billing specialists who know which questions to ask in order to have an accurate idea of your reimbursement rate. After the birth, these same companies for a nominal fee will also submit a superbill on your behalf. I find this, along with a phone call (or two or three) by the parents to be the best way for families to recoup their costs. Because typically it’s cash up front, anywhere from $2000-$5000 depending on where in the country you are, and then reimbursement after the birth. Here is one father’s account of getting reimbursed for their home birth. And here is a comprehensive list of questions to ask your insurance provider. I find that most families get something back. Home birth is at least half the price of an unmedicated vaginal birth, and it only goes up with intervention, so for many families and insurance companies, home birth is the most affordable option.
4. What happens in an emergency? What if we need to go the hospital? Birth doesn’t always stay at home. For myriad reasons, we may find ourselves in the hospital. My transfer rate is less than 10%, but still, there are eventualities that may land you there. It is a common concern amongst home birth parents, and those that prepare for it, are almost always the ones who stay out of the hospital! I like to go through the emergency plan at the 36 week visit. We write down all of the numbers we need in case of emergency, discuss what it would like and where we would go. I bring out my oxygen tank, my neonatal resuscitation equipment so that it’s not frightening in case we need to use it.
Midwives are trained and skilled to deal with emergencies. We take neonatal resuscitation, and adult CPR training. I practice the timing of resuscitation breathing on my way to each birth. We carry anti-hemorrhagic medications and are knowledgeable about when and how to use them. Midwives are trained in normal birth, so when abnormal situations arise, we can spot them easily and readily. 911 is called and we provide palliative care until the emergency team takes over.
Each area of the country differs in how non emergency transfers are handled, with everything from ER drop offs, to the midwife staying through until the end. Here in the Bay Area it typically looks like this; I phone the Labor and Delivery unit to explain why we are coming in, your chart is then faxed ahead of your arrival. We go to the hospital and I stay until you and baby are snuggled. This is a compelling post from a friend/former client detailing all of the emotions that go into a hospital transfer.
5. Is it legal?! Can I get a birth certificate? Up until the 1930’s most American women delivered their babies with the help of a midwife. In the countries with the best maternal and infant statistics today, midwifery care is the standard for healthy pregnant women. Once birth moved from home to hospital in the U.S., midwives were pushed out of the birth room, and are just now, reentering that space.
Check the chart to the right to see if CPM, Certified Professional Midwives (the midwives who attend the vast majority of home births), are legal in your state.
If midwifery is legal in your state, getting a birth certificate is a piece of cake. I’m not sure what it’s like in states where it’s not legal, but I imagine it’s not difficult. Here in California, I fill out some paperwork, and you take it to the Department of Vital Statistics, and a couple of weeks later, the birth certificate is in your mailbox.
I hope this cleared some things up. Keep asking questions. If home birth is whispering it’s sweet song in your heart, follow it, you will be glad you did. If you are in the Bay Area and are interested in my home birth services, feel free to contact me with any further, burning questions!
This post was shared at Real Food Wednesday, Party Wave Wednesday, and Wellness Wednesday.