Home & Water Birth – A certified doula answers common questions on home birth

Expectant parents who are interested in birthing at home commonly ask the following questions:

What are the benefits of a home birth?

Giving birth at home offers many things that a hospital cannot provide, such as privacy, the comfort of your own home and bedroom, the opportunity to sleep in your own bed and to snuggle with your partner. Mothers experience support for natural birth and true freedom of movement for laboring and birthing in the positions that they choose.

Home birth midwives are trained in the emergency medical care of mothers and newborns.

When preparing for home births, the midwife gets to know each family very well, as she tends to spend an hour on each prenatal visit. She will care for you during labor, often with the help of an assistant. This is very different from hospitals, where many staff members are in and out of the room. Overall, mothers who give birth at home enjoy the experience, with “over 97 percent reporting that they were extremely or very satisfied,” according to a home birth study that appeared in the journal British American Journal (June, 2005).

Is home birth safe?

The following statistics illustrate the success of home birth. These numbers were compiled from a study of the North American Registry of Midwives and published in the British Medical Journal, June 2005.

Studies on home birth show that “Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6 percent versus 84.3 percent), episiotomy (2.1 percent versus 33.0 percent), [Cesarean] section (3.7 percent versus 19.0 percent) and vacuum extraction (0.6 percent versus 5.5 percent).”

The Cesarean rate for intended home births was 8.3 percent among primiparous women (first-time mothers) and 1.6 percent among multiparous women (those who have previously given birth).

The study compared medical intervention rates for the planned home births with data from birth certificates for all 3,360,868 singletons, vertex (head-down) births at 37 weeks or more gestation in the United States in 2000, as reported by the National Center for Health Statistics. It was found that “655 (12.1 percent) women who intended to deliver at home when labor began were transferred to hospital. Medical intervention rates included epidural (4.7 percent), episiotomy (2.1 percent), forceps (1.0 percent), vacuum extraction (0.6 percent) and [Cesarean] section (3.7 percent); these rates were substantially lower than for low-risk U.S. women having hospital births.”

“Planned home births with certified professional midwives in the United States had similar rates of intrapartum and neonatal mortality to those of low-risk hospital births.”

“Medical intervention rates for planned home births were lower than for planned low-risk hospital births,” even when a transfer to the hospital occurred.

Who can have a home birth?

A good candidate for home birth is a woman who truly wants to give birth at home. Also, she must be considered “low-risk” by the medical establishment. Home birth midwives screen clients for continued health during pregnancy and may refer women to hospital providers if certain symptoms appear.

What if there is an emergency?

Home birth midwives are trained in emergency medical care of mothers and newborns. They carry blood pressure cuffs, stethoscopes, oxygen tanks, suction devices and medications to stop bleeding. Because they are providing care for one family at a time, they are almost continuously observing mother and baby.

Midwives can recognize when a situation arises that requires a specialist or ongoing medical care. If that is the case, they will transfer care or make a referral. If it is an emergency that is best dealt with at the hospital, they will call an ambulance and provide care until help arrives. Sometimes a home birth midwife is able to stay with a mother to offer support through the rest of her labor.

Hospitals use large monitors to listen to the baby. How does a home birth midwife monitor the baby?

Home birth midwives do listen to the baby’s heart rate. They use a hand-held monitor, which is called a Doppler, to listen to the baby. They will count the number of times that the baby’s heart is beating and then record it in the chart. Fluctuations in the baby’s heart rate are detectable in this way and can even be heard while the mom is in the bathtub or shower.

Can I have a water birth at home?

Water birth is much more accessible to women who are choosing to birth at home. However, you will want to inquire about water birth with each midwife that you interview. Most midwives do encourage women to use water as a comfort measure.

Some homebirth midwives rent or provide a fancy portable tub, some suggest purchasing an inflatable kiddie pool and others will simply accommodate the mother who is bathing in her own bathtub. In the hospital, water birth is rare.

My family is concerned about home birth. How can we alleviate their fears and feel empowered by our decision?

Sometimes sharing what you have learned about home birth and hospital birth can help your family see your perspective. It can be helpful to surround yourself with support for your decision by spending time with mothers who have birthed at home or without medication. Borrowing midwifery centered books and videos is very important. If possible, attend childbirth classes with your midwife or another independent and homebirth-friendly teacher.

How do parents prepare for a home birth?

Much of the preparation for home birth involves prenatal nutrition and exercise, in order to be a healthy candidate for home birth. Parents who are choosing home birth are agreeing to take on a few responsibilities that aren’t part of hospital birth. For example, parents need to obtain certain birth supplies and keep them on hand, such as extra towels and washcloths, which need to be clean and ready for the birth. Chux pads, menstrual pads, olive oil, herbs and a Crock Pot are some things your midwife may request. A small bottle of olive oil is usually used for a perineal massage instead of petroleum jelly.

The Crock-Pot can be used to heat water for the warm compresses, which help soften perineal tissues and ease the discomfort of crowning. Some midwives suggest adding healing herbs to sitz baths that mothers take in the days following birth.

Parents are expecting to care for their baby right away following birth and after, knowing that he or she is not going to the nursery. Parents may also want to plan for a friend or family member to be present to help with cooking and laundry.

Is a home birth sterile?

Midwives carry sterilized tools for births, chux pads, gauze, needles, suction devices and gloves. The woman’s home environment contains germs and bacteria that she is already accustomed to, so they are not a threat to her or the baby. Laboring and birthing on clean sheets and in a clean tub is sufficient. The midwife will spread chux pads under the woman’s bottom as the baby is being born and again following the birth.

What if I need stitches?

Many homebirth midwives can give stitches if they are necessary. They also carry medication to numb the tissue first. The best news is that there seems to be less need for stitches in a home birth setting, probably because women who are not medicated can push with the rhythm of their bodies without pushing too hard or fast. At home, mothers have greater freedom of movement, including the opportunity to spontaneously choose their birth position. Home birth midwives provide excellent perineal support during pushing.

What do home births have to offer babies?

Babies benefit from home births, too! It begins with the nutritional counseling that mothers receive from their midwives during pregnancy.

During their births there will be fewer interventions, as well as after they are born. Home-birthed babies do not have drugs in their systems. Also, midwives are likely to wait for the umbilical cord to stop pulsating before clamping it, which benefits the newborn.

At home, mothers and babies are not separated. Babies are given immediately to their mothers and are not taken away. Establishing breastfeeding is the primary goal. Eye ointment, vitamin K and measurements are postponed until baby has nursed successfully. The newborn exam can be carried out on the bed right next to the mother.

Families receive much support for breastfeeding and are not offered formula when they give birth at home. The combination of no separation and increased support leads to greater success with breastfeeding.

According to the study in the British American Journal, “At six weeks postpartum, 95.8 percent of these women were still breastfeeding their babies, 89.7 percent exclusively.”

I already have children. Can they attend the birth?

Home birth tends to be very family centered. If you would like to include other children in the labor or birth, plan it in advance. Practice deep breathing, make birth sounds and read books about home birth together. It is recommended that an adult other than your partner be present to tend to the needs of the children, who may want to watch their mother or may prefer to play in another room. The babysitter should be someone who is flexible and not attached to witnessing the birth.

How can we pay for a home birth?

Some midwives are able to accept insurance or can be billed as an out of network provider. Some midwives work with Medicaid. It seems that they all offer payment plans, so that families can pay their balance off throughout the pregnancy. If a home birth must be paid for out of pocket, parents might consider asking for “birth bucks” instead of baby shower gifts.

“An economic analysis found that an uncomplicated vaginal birth in hospital in the United States cost on average three times as much as a similar birth at home with a midwife,” according to the home birth study.