Ballpark Estimate: $4,400
Ideas about childbirth methods have changed from generation to generation. Birthing methods that were taken for granted by our grandparents gave way to other ideas, which in turn will likely give way to yet other notions that our children will espouse. However, regardless of trends that come and go, homebirth has stood the test of time.
Homebirths are often characterized as either assisted or unassisted. For the purposes of this article, we will assume the use of a midwife in a planned, assisted homebirth.
Making the Decision
Certainly, the decision to homebirth your child is an intensely personal one, and each couple will have their personal reasons supporting their choice. But beyond these personal reasons, most homebirth parents agree on a common overriding theme: that pregnancy, labor and birth are parts of a normal process that can progress without the need for medical intervention. In other words, while medical technology can be invaluable for an acute or urgent medical need, some parents believe it may interfere when imposed on a healthy pregnancy and normal birth.
Of course, some high-risk pregnancies may not be good homebirth candidates. Midwives are specialists in “normal” pregnancies and deliveries, so parents who are in a potentially high-risk pregnancy should consult their doctor and midwife to determine whether homebirth is a safe option for them.
It’s also helpful to keep in mind that the decision to birth your baby at home requires a high degree of commitment by parents. Homebirth parents must prepare themselves to labor and birth naturally without the aid of medications for pain and labor inducement. The Birthsong Childbirth Education and Support Serviceswebisite discusses the benefits and risks of using these medications versus not using them.
Affecting your decision to homebirth will be the current legal status of midwifery practice in your state. A brief description of the legal status in each state can be found at Midwives Alliance of North America (MANA).
Midwife Qualifications and Credentials
Once the decision is made to use a midwife in a homebirth, you will want to consider a number of other factors when selecting a midwife. Very important among these factors is her experience. Her experience will be measured by the number of years she has practiced as a midwife and the number of births she has attended. During your interview, you will also want to discuss those deliveries that were unusual and that required her to intervene for the safety of the mother or child. A midwife’s candor about her experience should satisfy your need to have a sense of her competence and should also tell you whether her personality will “click” with yours. It is important that midwife and mother have a comfortable rapport that fosters honesty and that will lay the groundwork for a satisfying birthing experience.
Equally important to know is the midwife’s education and certification. Generally, a midwife is either a direct-entry midwife (DEM) or a nurse midwife, the primary difference between these two being the completion of the requirements of a registered nurse. While the credentials are different, both direct-entry and nurse midwives must complete similar focused training, education and examination to be certified by the American Midwifery Certification Board (AMCB). Once certified, they are designated as either Certified Midwife (CM) or Certified Nurse Midwife (CNM).
Other important designations include Licensed Midwife (LM), which indicates that a midwife is licensed to practice within a designated state, and Certified Professional Midwife (CPM), which refers to certification by the North American Registry of Midwives (NARM), an international certifying agency.
Since the midwifery model of care revolves around an understanding that childbirth is not merely a physical or medical procedure but is an experience that involves the whole person, most midwives seek to address and accommodate a broad range of needs and concerns, including the following:
- Your midwife will respect and accommodate the parents’ traditions and beliefs related to childbirth.
- Your midwife will provide unhurried attention during appointments. Appointments are typically hour-long meetings with your midwife and possibly also with a midwife associate and intern. These appointments are scheduled monthly through month six, switch to every other week until the last month, and then are scheduled weekly until the birth. The final one or two visits typically will take place at the mother’s home. Services usually also include three to six postpartum visits. Midwives typically work in close association with each other within their geographic area so that they can back each other up as needed, for example if your midwife happens to be attending another birth when you begin labor.
- Your midwife will monitor the health of mom and baby throughout the pregnancy, during labor and after birth. Midwives are able to prescribe and interpret diagnostic test results obtained from blood, urine and vaginal swipe samples to make certain health assessments. She is often able to prescribe effective, natural remedies using herbs and homeopathy to correct some conditions with the objective of reducing the risk of complication during labor and delivery.
- She will refer mom to other healthcare professionals, including doctors, when she recognizes early signs of a situation or condition that is not “normal” and that she cannot effectively address herself.
- Importantly, the midwife will help mom discover her body’s own innate ability to give birth. She will coach and educate mom so that together they proactively minimize the risk of complication during birth.
- She will teach mom skills to cope with discomfort during labor and that will encourage normal progression of her labor.
- The midwife will provide parents with an abundance of information to enable them to make good choices about such things as prenatal care, newborn infant care, nutrition, breastfeeding, circumcision, et cetera.
- She will provide invaluable attention, encouragement and emotional support throughout labor. Studies have shown that having sympathetic female support during labor reduces the risk of complication.
- She will orchestrate activities during labor and birth to ensure the safety and comfort of mom and baby. She will recognize early signs of distress and prescribe timely corrective measures.
The best referral for a midwife is a personal referral from someone who has had a safe and satisfying homebirth experience. If you do not know anyone personally who can provide a referral, begin making contacts with trusted sources that can provide a referral. For example, you could begin networking with related organizations, such as your local chapter of La Leche League, with the objective of finding midwife referrals. If you cannot obtain a personal referral, you can begin your search online at any of a number of sites, such as American College of Nurse-Midwives.
What It Costs
For her services, a midwife typically will charge a single, comprehensive fee. Since fees vary widely regionally, let’s consider northern California as an example. Here, fees for the services listed above average $4,200. Some midwives will offer discounts if you are able to make a lump sum, upfront payment.
In addition to the midwife’s fee, you may incur other costs related to preparing your home for the birth event. These other supplies may include the following.
- Supplies that will be needed during labor and birth include such items as plastic-backed mattress covers, cold packs, sterile gloves, absorbent pads, peri bottles, herbal bath mixes, etc. These may be purchased separately or in kits from suppliers such as In His Hands Birth Supply. Birthing kits range in price from $25 for a basic kit and up for custom kits that your midwife can design and order for you.
- Many homebirth parents choose to give birth in warm water as a natural way to manage the discomfort associated with labor and delivery. Some also believe that water birth eases the baby’s transition to the outside world. If you plan on giving birth in water, you may use a large bathtub in your home. However, if your tub and bathroom are not conducive for this purpose, a portable, inflatable pool can be set up in a room of your home that is close to a warm water source, such as your master bedroom. Birthing pools come in a wide range of prices from $25 to $400 depending on design. I-beam wall designs are most popular for homebirths since this wall design resists collapse and is rigid enough to lean on. Prices for this design begin at around $125. Most birthing pools are made without the use of potentially harmful materials, such as phthalates. Check the manufacturers label to be sure.
- For water births, you will also need some related items such as an air pump to inflate your pool ($9 to $30 depending on whether manual or electric), a non-toxic water hose long enough to connect your warm water source (e.g. shower head) to your birthing pool ($20 for a 50 foot x 5/8 inch hose), an adapter to connect hose to your bathroom water source ($2 to $6), and a water pump to drain the pool after the birth ($11 for drill-operated to $90 for electric submersible). Birthing pools and related supplies are available from many sources such as Your Water Birth.
Since most health insurance policies do not cover homebirth-related costs, homebirth parents must be prepared to bear all of these costs themselves. Check your insurance policy to determine what homebirth costs, if any, your insurance company will pay.
There are a few things you’ll want to do after giving birth to your baby. Very important among these is to register your child’s birth with your state’s Department of Health & Human Services in order to be issued a birth certificate. There is generally no cost to do this, but there are records to assemble and documents to be completed. Visit your state’s website for details.
Once your baby’s birth is registered with your state, you may apply for a Social Security card for your baby if you so desire. There is no cost to do this. A child’s Social Security number typically is required on tax forms when claiming them as a dependent.
Childbirth is one of life’s special events. For many, framing that special event in the context of their home, assisted by a midwife, makes it a more satisfying and memorable experience.