Question for Homebirthers

[cream_city]

I'm thinking ahead and considering a non-hospital birth. I'm 35, healthy, and had a fairly easy vaginal delivery with my first child. I did have interventions, however -- antibiotics and pit, then an epidural in part because of the pit and in part because I couldn't move around.

We've moved since then (Simon was born 5 years ago), so I'm trying to figure out options in a new community. Here's what I'm looking at so far:

My current ob/gyn delivers at a hospital birth center that seems fairly progressive -- they offer doulas for a small fee, have hydrotherapy tubs and birthing balls, etc. You also stay in a single room for your entire stay.

We also have a freestanding birth center nearby. It doesn't have a midwife staff, however -- you have to make those arrangements on your own, which seems a little overwhelming to me right now. We've only lived in this area for a year, so I don't really have access to word-of-mouth.

And, if I need to set things up with an independent midwife anyway, then I wonder if I should just be considering doing this at home. I live about 15 minutes from the nearest hospital.

I guess I'm curious as to what people think -- what advantages would there be to the freestanding birth center over home?

Also, I'm a worrier. I know that part of the reason home birth is appealing is because you can be more relaxed, in a familiar environment that you control. But if I am worried about things going wrong and being too far from the hospital, do you think that would undermine the advantages?

I have more questions, but this is probably long enough.TIA.

[Sashahomeschoolmama]

There are no longer any birth centers in my state, so I can't comment for or against them. I can say, however, that I had my youngest at a progressive hospital that sounds like what you described. Still, I was kept from eating (even though I hadn't eaten the entire day and was starving), given an IV with pitocin (I didn't want pit but wasn't asked), had EFM once an hour, was checked when the doctor wanted me checked, gave birth in the on-the-back-knees-up position after being told to PUSH-PUSH-PUSH-PUSH-PUSH, then the baby was given vitamin K and eye goop directly after birth. The baby and I did things on their schedule, not the other way around. While dh was involved in after-birth things (cutting the cord, watching the newborn check-up) I was confined to the bed, unable to really see what was happening with my baby.

Contrast that with a homebirth I was at this morning--Mom was in labor for a few days on and off (her cx would peter out) and that was fine. She ate, drank, and did whatever she felt like doing. She had one cervical check at her request. She pushed when she felt like pushing, delivered a baby with no problems, and her son cut the cord (AFAIK even the most progressive hospitals don't allow children to be present at births). No Vitamin K, no eye goop. We waited for Mom to eat, relax, and with her permission the baby had the newborn check-up with Mom laying right beside it.

Hospitals mean that you are going to abide by routine policies. Those routine policies might be okay with you. If they're not, even the most 'progressive' hospital probably isn't for you.

As for being worried that something could go wrong, I guess for me it helps to know that things are more likely to go wrong once interventions have been introduced into the labor equation. I also trust my midwife to know if there is a need to head to the hospital.

Between a birth center and homebirth, I'd think that, in the case of a dire emergency, you wouldn't make it to the hospital in time either way to make a big difference in the outcome. According to my midwife, however, those emergencies are very few and far between (certainly far less frequently than "emergencies" in the hospital setting and I firmly believe that most of those emergencies are caused by the interventions in the first place); the majority of transports happen with plenty of time and are for things like failure to progress, maternal exhaustion, and so on, where you would be able to make it easily from either your home or the birth center.

[cream_city]

Sasha -- do you have a backup doctor? If so, how did you arrange that? Also, how did you go about selecting your midwife? Thanks!

[Sashahomeschoolmama]

My midwife has a backup OB that her patients see at least 3 times throughout their pregnancies (once per trimester). All of the midwives in this area use him. In my state home midwives are illegal so he's really their umbrella protection (which is very nice). I just called his office, told the nurse that I was so-and-so midwife's client, and made my second trimester appointment. He's very hands-off with his homebirthers--I've had full control over what testing to accept or decline.

I've been to a few different homebirths so I knew what I *didn't* want in a midwife. There was one who was actually targetted by our state a couple of years ago and threatened with prison--I was drawn to her because of this unfairness. After having a few phone conversations with other midwives I made an appointment to meet with her and we hit it off.

[cream_city]

I just got off the phone with our insurance company. They will cover midwife services, but they have no midwives approved in network. So if we do decide on a homebirth -- and I've been really warming to the idea -- we'll have to pay out of pocket. I shouldn't be surprised, but it's disappointing. Our insurance, in general, is great.

[LiquidLove]

Our hospitals where I live are not terribly birth friendly. My midwife prefers the largest one, which is furthest from me, if you "must" go in for a non emergency situation. There is a birth enter about 45 minutes from me. I know a lot of women who have had great experiences there. When I did the tour there, though, it felt like a hospital room with a four poster bed in it. The whole thing was just still very sterile looking and spartan, and I didnt like it. I had been vascillating between birth center and homebirth, and taking the tour just really helped me see that I didnt feel like they could provide me with any more or better services than my homebirth midwife. The only plus would be that the midwives at the birth center had priviledges at the hospital down the road, so my care would have been consistent if I had needed to transfer, whereas that would not have been true with a homebirth transfer.

I got my midwife rec's from going to La Leche League meetings and asking people who they used. At the time, 5 yrs ago, they all used the same midwife. So I used her, and we developed a friendship. I have used her for my last 3 births.


For us, it was more important to have an out of hospital birth than to have the birth covered by insurance. With our first birth (hospital, 1999, Winchester,Tennessee) we had a $10 co-pay or something, and the entire thing was covered. I didnt have a bad experience in the hospital, it was just not something I wished to repeat, with the rules and thge Babywise preaching nursing staff (and the no meds birth sideshow I became and the floodlights and stadium seating for all the nurses). Our second birth was at home, and under DH's then current insurance, they paid for everything EXCEPT the actual birth.. so they covered all testing and prenatal and post natal care, but not the night of the birth itself. We paid $700 for that.

Our second homebirth (my third birth), my midwife didnt make it in time to catch the baby! So we didnt have to pay for that birth, but we DID have to pay for all the visits pre and post without insurance. I think our total was under $2000. Our third homebirth (my fourth birth), we paid out of pocket for everything, pre and post natal and the birth, and it was right around $2000. It is something we budget for once we know we are expecting. There is a local CNM to us who takes our insurance. But I have a friendship as well as a birthing history with my CPM, and would rather pay full price for her care.

Musing on why I like homebirth...
Im not treated like a patient, so I dont feel like Ive come through major surgery because no one is treating me like that.
Freedom of birth attendant choice, freedom of birthing methods
Ability to eat and drink as necessary
Ability to use my own toilet and shower before during and after the birth

Probably my biggest reason
***The comfort and watchfulness my midwife provides as I am her entire focus during labor and birth, with no other rooms, no orders from other places, no distractions. She is right there and I have more confidence in her ability to know if something is wrong and we need a transfer than the confidence I would have in a labor and delivery nurse that comes in the room every 10-15 minutes while checking other patients and doing other duties.*** (I have had a hospital birth to compare my confidence in staff with). My midwife brings an assistant, and that assistant is in charge of prep work and behind the scenes action, so as not to distract my midwife from me and my baby, so she doesn't even have to get anything set up.


Confidence in my midwife that she is there to facilitate the normal natural occurence of birth and not do anything to get in the way of nature taking its course and my body doing what it wants to do in the birthing process.

Further confidence in my midwife that she has mine and my baby's best interest at heart for safety and everything. I happen to be more than her client, my midwife is one of my friends.

Knowing that statistically, the likelihood of needing intervention at all goes way down when you are not induced or augmented by medication, and when you are not on your back with an epidural. When I have freedom of movement and awareness of all sensation, and nature has taken its course in deciding when baby should be born, that there is not much likelihood that I will need hospital attention if my midwife is prepared and knowledgeable.

Knowing that my midwife has extensive experience in birth, has a certification for childbirth that she renews by taking continuing education classes each year, that she has oxygen, pitocin or similar, and any number of other lifesaving pieces of equipment that might be necessary.

And I guess another large thing would be that because of the nature of our friendship, and her openness as a CPM, I am able to ask questions about her birth experiences with other clients (not by name of course!). I dont know if others have this experience with their homebirth midwives, but I can't imagine it being acceptable to ask questions about my OBs history and get answers to probing questions. I can find out how many women have transferred and for what reasons, what neat new experiences she has had (like a baby born face first, or with a nuchal elbow presenting with the crown, etc) and can have a meaningful dailogue about these and other concerns during our hour long one on one prenatal visits.

I'm sure if my baby were't demanding my attention I could come up with many many more reasons why I prefer homebirth, but this is off the top of my head on little sleep.

You do pay your attendents, and you are not responsible for any mess you make as a birthing woman during labor, during birth, or after the birth. I have never attended to my own birthing cleanup. Just in case the mess idea keeps you from wanting a homebirth.

[cream_city]

Thanks LiquidLove! I am leaning toward homebirth over a birth center, because I am not sure there enough advantages, and I think I'd obviously feel more at home in my own home.

On the one hand, I feel like I'm being a little self-indulgent to think of spending money we don't have to in order to have a home birth. But then, I think, there really is a lot at stake and I should do what I think is best.

Plus, I hate to let an insurance company dictate how my birth should be!

I'm also scared to even ask my current ob if she'd serve as a back-up doctor...

Do you think a 15-minute drive to the hospital is anything to worry about?

[Babyblue]

we have a 30-45 min (or longer in traffic) drive to any hospital...so 15 is nothing to worry about to me.

[Sashahomeschoolmama]

If it helps, we have to pay out of pocket for our homebirth (my insurance pays for the back-up OB care since the presumption is that he'll be the attending OB at the hospital) but we pay OOP for the midwife. We do not have $1600 sitting around--that is a lot of money to us. But it's worth it to have the birth that I want.

I don't think that a 15 minute drive is anything to worry about. When I was trying to decide whether or not to have this birth at my house or my mom's house I asked my midwife about the distance. My house is about 10 minutes away from a crappy county hospital (seriously, it's medieval. They don't allow rooming in and only allow mothers to see their babies at scheduled times) and about 40 minutes away from a nicer hospital.

My mom's house is about 10 minutes or so from the nicer hospital.

My midwife said that there was no reason to factor that into my decision. She said we'd have time to travel to the nicer hospital either way.

[LiquidLove]

I think a 15 minute drive is accetable. It would take the ambulance longer to reach you and get you to the ER.

I can only think of a few "time is of the essence" issues in getting the the hospital, two being a prolapsed cord (which can happen when your water breaks even if you were planning a hospital birth, so its not exactly a homebirth issue) and a hemmorhage that your midwife hasnt gotten to slow well enough with her own medications, solutions, and herbs. Baby having trouble/not breathing might be an issue, but your midwife should have a baby ambu bag and an oxygen tank. My midwife has had to give breathing assistance to a lot of babies (my most recent included), and none have ever required transfer after her help.

Im sure naysayers might come up with a host of other possibilities, but those are the most serious I can currently think of). I am by no means an expert as I havent studied midwifery, so I dont have a refute for every claim that something might go wrong. But my midwife points to those as her most serious reasons for transfer, and anthing other than those, she has dealt with.