As a first time mom, everything is so new! You are brimming with excitement, anxiety, and most of all, questions! There are many reasons new parents may choose to hire a midwife and give birth at home or a birth center.
In my years of helping birthing people, I have heard countless mothers say that they “wanted a home birth, but my [partner, mother, family, mother-in-law, etc.] thought it was too dangerous” or they heard first time births were more likely to result in a transport anyway. The first is simply a myth. The second was shown in one major study, but two other major studies showed that transport rate for first timers is not significantly different. A first baby does NOT rule out a home birth for you! The vast majority of first time mothers who plan out of hospital births do so successfully!
This article will address the concerns of first time parents and compare and contrast and midwifery versus hospital care, and give you some topics to consider when choosing a pregnancy care provider.
“The experience of childbirth plays a major role in how first-time mothers will develop good self-esteem, positive feelings for the baby, and an easier adjustment to motherhood role, and also future childbirth experiences.”
1. You will have more choices.
“To be empowered increases first-time mothers’ chances for a positive birth experience.”
Research shows that being given genuine choices in health care improves satisfaction with birth and reduces traumatic experiences. Midwifery care strives to give you choice and responsibility for yourself and your growing baby.
At home, you get to choose every part of your care, ranging from which lab tests to do, which treatments you will receive, and how you will labor and give birth. Most hospital providers, such as obstetricians and hospital-based nurse midwives, operate under the restrictions of hospital protocols, insurance companies, and lack of education about nutrition and alternative treatments. This results in less freedom of choice for you.
For example, if you test positive for Group Beta Strep, at the hospital you will be only given one option: IV antibiotics during labor. Many midwives, on the other hand, will share with you the benefits and risks of different types of treatment and advise based your risk factors and your preferences. You may be given the choices of herbal treatment and re-test, an antiseptic vaginal wash during labor, no treatment, or antibiotics during labor, which is considered the medical standard of care.
A lot of people have misconceptions about what modern midwives do. Many people think we are largely untrained, unsafe, and do not practice modern healthcare. This is a myth based on lack of understanding. Modern midwives care for low-risk childbearing women. We are trained to monitor the health of mother and baby, prevent and recognize complications, do lab work, provide newborn care, and so much more. There is a national and rigorous certifying credential called the Certified Professional Midwife (CPM), which many midwives choose to complete. In many states, midwives are required to be licensed by the state in order to practice. Midwifery training is very much like a nursing or any other healthcare program in that we are trained in both academics and hands on skill before ever going into practice on our own.
You and your baby are less likely to get an infection at home.
You are more likely to successfully breastfeed: in the United States, non-breastfed babies had a 25% higher mortality rate than breastfed babies.
For a low risk mother and baby, out of hospital birth has proven to be as safe as hospital birth, with fewer interventions. “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”
Your midwifery care will provide more prevention than hospital based care with diet, supplementation, and exercise recommendations tailored to you. Due to these early interventions, we see lower rates of pre-eclampsia and gestational diabetes than a practice where these preventative topics are not addressed. If your midwife see an issue in labor, she is more likely to address it early since she is in touch with or present with you from an earlier stage of labor than a physician would be.
3. You are far less likely to need an induction or a cesarean section.
“Intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women.”
Overall cesarean rates in the hospital are around 30%. C-Sections are associated with greater maternal and infant complications including blood loss, infection, chronic pain, and other issues. “Children born by C-section have been more frequently hospitalized than those born vaginally due to asthma, juvenile rheumatoid arthritis, inflammatory bowel disorder, immune system defects, leukemia, and other tissue disorders during their lives.” Many hospitals still do not allow Vaginal Birth After Cesarean (VBAC), so if you choose the hospital and end up with a C-section, your chance of having a vaginal birth next time may decrease as well.
However—if your first time birth does become one that ends up at the hospital, you’ll know you REALLY needed it, and won’t have to question whether your induction/cesarean/epidural, etc. were truly necessary.
4. Continuity of Care
In most out of hospital birth practices, you will see the same midwife for the entirety of your prenatal, birth, and postpartum care. Trust, presence, responsiveness, and individualized support from your healthcare provider have been identified as highly influential factors in a positive childbirth experience. By the end of your pregnancy, you will know each other’s personalities and practice preferences, which builds trust in one another.
At the hospital, you may see the same OB or CNM for a few minutes of your visit, but other medical assistants and attendants will vary and rotate throughout your care. In some hospitals, your doctor just depends on who is on call that day and may be someone you have never met, or a provider whose personality and practice preferences clash with your own. Your provider influences your healthcare more than anyone except yourself, so choose wisely!
5. We really know you.
Since you have an ongoing relationship with your midwife, you are not just another number in our clinic. Most midwives only take between 4—8 births per month maximum. This minimizes the chance that we will be called for two births at once and allows us to form deeper relationships with each client. By the time you give birth, we will know what your ideal birth looks like, and how to maximize your chance of getting that. We know whether you want quiet or words of support, if you would like a water birth, who you want in the room, cultural preferences, and how best to support you.
6. You will receive more personalized information
Most home birth and birth center midwives have hour-long appointments, which allow plenty of time for discussion of all of your questions about pregnancy, childbirth, and the postpartum period. Most hospital-based providers only see you for 5—15 minutes at a time, which simply doesn’t give enough time for most new parents’ curiosities. We will discuss diet, exercise, birth plans, emotional concerns, dealing with pregnancy discomforts, baby care, and so much more.
In addition to in person information, many midwives will send you home with tons of recommendations for books, websites, and other resources that will support your growth as a new parent. Plus you have access to us via text or telephone nearly all the time! You will likely never have your OB’s cell number to be able to ask questions between appointments or give timely updates on health information.
7. Emotional Support
In addition to providing essential information during extended prenatal and postpartum appointments, midwives provide an immense amount of emotional support. As new parents, there are a lot of new emotions for you and your partner to process.
8. Partner & Family Involvement
This is a benefit of home birth that is rarely discussed, but many find as an unexpected benefit! At home, your partner has a tremendous role in your birth! They can help you prepare the birth room, support you in labor, and even help catch the baby! Many dads at the hospital feel uncertain or lost at best, and unwanted or viewed as a nuisance by hospital staff at worst.
Many midwives are enthusiastic about “helping you help her” during labor. They will show you massage techniques, encouraging words, and assure you when you are afraid or confused. Some partners decide that they would like to help with the delivery of the baby, having their hands on their child as soon as they emerge from the womb. This is a very special bonding moment for the entire family. We also encourage partners to cut the umbilical cord, dress baby for the first time, and help the mother with tasks around the house, which is crucial during the first several weeks.
If you have friends, family, or children you desire at your labor, you are welcome to invite whomever you choose! However, most midwives will encourage judicious selection of only those who will support you and not bring negativity or distraction to your birth experiences. Children are welcome as well, particularly if they are well prepared for birth and have an additional adult to watch them if they become bored, scared, or unruly.
9. Financial Savings
If you do not have insurance, or if your co-pay/deductible is high, home birth is almost certainly a most cost-effective financial decision than hospital birth. Home birth costs on average of $3000—6000, which includes prenatal care, labor and delivery, and postpartum care. An unmedicated, uncomplicated vaginal birth at the hospital averages $9,600 in the United States. An uncomplicated cesarean section costs about $15,800. And that’s not even including prenatal care, postpartum care, or lactation assistance.
Although insurance companies vary on whether they will cover home birth, almost all companies at least cover lab tests, ultrasounds, and transport or medical consultation if it becomes necessary.