For each person who contacts me in search of a home birth midwife, I know that there are three others (give or take) who are just starting to explore the idea of birthing at home and pondering whether or not they want to walk that journey. Here are some things to mull over as you consider this option:
- Do you feel confident in your body’s ability to grow, birth, and nurture your baby with minimal intervention?
You must start out with a respect for the natural processes of pregnancy, birth, and breastfeeding in order to be comfortable with birthing at home. Though we do plenty of screening and assessing from your very first visit, we do not treat disease or manage risk. Instead, we support these processes and refer when necessary. Unfortunately, many of us become pregnant with a variety of “scripts” in our head. Perhaps you have been told that all first-time mothers need an episiotomy, or “you think you want an unmedicated labor, but just wait…” Can you filter these scripts and feel confident that your body was made to birth this baby? Don’t get me wrong. Sometimes interventions are necessary, and when they are we change plans. But if you’re counting on Plan B to happen, there is little chance Plan A will.
- Are you willing to accept responsibility for making major decisions regarding your care?
With home birth, you are the ultimate decision-maker. Your midwife will provide options, explain risks and benefits, and even sometimes weigh in with her viewpoint. But, in the end, it is you who is calling the shots. In theory, this is true with any health care provider (you do have the right to refuse any test or treatment), but the reality is that the protocols and procedures you’ll find in an institutional setting are often stringent, and there is little room for disagreement. On the other hand, this means that you need to feel good about your decisions, even if a complication arises as a result.
- Do you feel comfortable in your intended place of birth and support people?
Not only do you need to feel safe in your home, you need to feel comfortable. Many times a woman isn’t even settled into her own space, but living with friends or relatives. While this can be fine, it can also make her feel inhibited or uncomfortable. Sometimes the other people in the home have palpable doubts about homebirth, which can create anxiety come birth time. Even if your support team is fully on board with birthing at home, sometimes too many people at a birth can be distracting and counterproductive. Consider where you’ll be, who you plan to attend your birth, and whether they are able to fully support you.
- Do you feel safer with experts or with knowledgeable, supportive caregivers?
Make no mistake, midwives are not doctors. Though we have come a long way to being able to offer most routine testing, we are not physicians and our scope of care is far more limited. With a few exceptions, we (CPMs) do not have prescriptive authority, we only care for low-risk women, and we may need to refer you to another provider, either temporarily or permanently. And there are those rare situations where we may have a complication that would have been best handled in the hospital with emergency equipment. That being said, we are experts in normal, physiologic birth. We know how to facilitate the process through support and helpful suggestions (perhaps suggesting positional changes for a slower progressing labor). Because we don’t have access to many of the routine interventions used in the hospital, we only suggest their use in those situations where we’ve moved outside of the realm of normal. In the hospital, even if your labor is completely normal and you’re low-risk, you’re likely to experience interventions that aren’t strictly necessary, which often leads one down the cascade of interventions.
- Are you willing to question your assumptions, and answer others’ endless, and often inane, questions? Are you able to be counter cultural, seen as something of a zealot or odd-ball?
Home birth still isn’t even close to the norm. You will be questioned about your decision by many people–your mother, friends, and the grocery clerk. People will ask about the mess, the safety, and you’ll hear about 2000 people say that if their babies hadn’t been born in the hospital they all would have died. Sometimes home birth families smile and nod, and sometimes they educate. How will you be able to handle that?
- Are you willing to be changed forever?
Home birth is truly a beautiful, spiritual experience. We bring reverence with us, and protect your experience to the extent we are able. Though I see many uninterventive, beautiful hospital births, it is not the same as being at home, in your space, surrounded by love and peace. You’ll likely find yourself transformed and utterly empowered.