Frequently Asked Questions
Why homebirth?
For many people homebirth is simply the only option which matches their belief systems. Some have had to endure painful hospital experiences which alert them to the arbitrary nature of protocols in place there. For some it is a gradual education process which begins when the first visits to the local obstetrician end poorly and the family begins to seek other options. Some have several children before finally realizing homebirth was right for them all along. Some want control of the labor process, impossible with managed care, others want control of what happens to their baby in the hours after birth. Some want God to lead the process and others want to be simply left alone.
What bonds homebirthers together, because they come from all walks of life and all income levels and all religions and creeds, is a need to be at home and undisturbed and to let nature take its course gently and easily.
Birth at home is remarkably simple and comparatively easier than hospital birth. 90-95% of the time the baby is born at home and is healthy after a labor which while longer is often more pleasant than the typical medical birth experience. You can labor in water, move around to be comfortable, you can eat. You can let the aches and pains of a healthy muscular system work the way they should, and scream or cry or be totally silent. Your toddler can run around and your husband can be where you both feel safe and protected. To labor in your own big bed, and deliver there, and stay there and spend the night is such a gentle process. No wheeled transport, or little plastic boxes for the baby, your arms do just fine. Midwives clean up the mess and chat about the beauty of what they just saw and leave you comfy and clean.
So the question really is not, Why Homebirth. The question really is Why in the world would you do anything else?
Is homebirth safe?
Midwifery care has statistically better outcomes in all situations for all populations than any other form of birth care. Homebirth with a trained attendant and access to medical care has the best outcomes for low risk populations. No study anywhere had ever shown obstetrical care to be superior to midwifery care. Ever.
Most of the world population is born at home with a midwife, and with the exception of those with no access to emergency care, those outcomes are surprisingly good. Most of the industrialized world has better birth outcomes than we do and we lag behind our economic partners in defeating fetal and maternal mortality while leading them in birth interventions.
In our culture, hospital birth is currently the norm, not because it is safer, better or more comfortable but because it is what is done and has been done for the last 3 or 4 generations. Birth in hospital accounts for 3.8 million hospital admissions per year and is the single largest cause of hospital admissions. It is a huge industry, governed by largely arbitrary rules which are not in keeping with any known research or scientific method.
The careful screening midwives do make sure that problems with the mother or child which need hospitalization are there, whether in pregnancy, birth or postpartum. Transports happen, but for medical reasons, and the outcome is necessary, not routine. 5% world wide will need cesarean sections, and that is about how many need transport for surgery at home, compared to 25% in most hospitals. Small occurrences like a baby that needs mild resuscitation, or a mother that could use a few stitches, or needs a medication to stem bleeding from the placental site, can all be handled as a matter of course by a trained midwife.
The question really is not: Is homebirth safe, the question really is what is safer than homebirth? There is no response because nothing has ever been proven safer than homebirth for low risk women. That is one of the best kept secrets in the field.
How much will a homebirth cost?
Prices vary and are less expensive in the rural areas. Midwives around Philadelphia get $2000-$5000 for a home birth. Many other payment options exist: with a deposit and payment plans, any birth can be paid for the course of the pregnancy in smaller payments. Some midwives will barter for services and, some midwives take insurance. Successful campaigns have been waged with insurance companies regarding their policies on homebirth, so notify your insurance company in writing and with some effort, you might be pleasantly surprised at the outcome.
Keep in mind that there may be additional costs associated with the birth other than the fees of the midwife. These might include the cost of: a birth kit, supplies for the birth, doctor visits, prenatal tests, postnatal injections (RhoGam, etc.), renting a birth pool, Doula services, and newborn tests (PKU test, blood work, etc). (extra costs courtesy: www.nchomebirth.com)
But that is a lot of money!
People spend thousands of dollars and years of planning on a wedding, but typically they spend very little time or money planning for a birth. With the illusion of insurance handling all the fees for a birth in hospital it can seem like birth is free in the hospital. However, there is no such thing as a free lunch.
For those having a regular birth in hospital, fees usually start at $5000 and go up from there. Add about $1700 for epidurals needed because birth can be extremely painful when you cannot move around due to the fetal monitors, and various protocols in place, and on average 70-90% of women birthing in the hospital will use epidural pain medication. 1 in 4 women in hospital care will get a cesarean section because of a difference in how women are cared for at home rather than in hospital. A cesarean section can cost $7500 in hospital fees, anesthetic and doctor fees. For those without insurance that is all out of pocket costs.
Ambivalence is typical early on, and you will think of all the wonderful things you could spend the money on, and that it would be easier to just go with the practice that takes your insurance, but disagrees with your belief system. However, I know personally that I would have paid thousands more dollars to not experience the strain on my life that my first hospital birth experience cost me. The comparative ease of my homebirths were worth 10 times the cost. As a couple, the rift of our hospital experience reverberated through our relationship for years afterwards, teaching us the lessons of the age old midwifery adage: If Momma is not happy, nobody is happy.
It is painful for our family to look at the bank book and the positive pregnancy test and make the commitment to a homebirth, even though we pay a very sizable chunk every pay check for our medical insurance, which we carry just in case. But we do. We have a family joke about how we could spend the money now on the birth or invest it in Microsoft to pay for our therapy later. There are many other life circumstances where it is better to pay now and be happy, rather than be frugal and suffer the consequences. Certain things cannot be judged by how much they will cost, rather what it will mean over a lifetime.
An engagement ring costs 2 months salary, how much more is a baby worth? How much more are good memories worth? For those conflicting with spouses over control of the check book on this issue: How much are you worth? How much more is becoming a family in the privacy of your own home worth? How much more is that pregnant woman in your life worth? As the credit card ads tell us over and over: those kind of things are priceless. Simply priceless. The rest is only money.
