Who is the ideal candidate for a home birth?
I often get inquiries from families who want to know if they can safely birth at home. Often they’ve been led to believe their pregnancies are “high risk” because they are over 35, they’re overweight, they’ve had a prior cesarean, they weren’t supposed to be able to get pregnant in the first place, it is an IVF pregnancy, they had a previous pregnancy complication, a doctor once told them they are too small to give birth, etc. While Midwives typically only provide care for clients who are healthy and have low-risk pregnancies, none of the above mentioned circumstances automatically make a mom “high risk” from a midwifery perspective. Regardless, many who come into care with me and fall into those categories have been led to believe that they’ll need extra monitoring, will need to see a perinatologist throughout pregnancy in addition to regular OB care, will require lots of extra prenatal testing, and will need immediate access to every intervention during labor “just in case”. All of this without any discussion about risk assessment, prevention, and simply natural remedies to help keep things in the (very wide) range of normal.
Out-of-hospital birth with a midwife is a completely viable option for healthy, low-risk pregnant women. Even ACOG (the American College of Obstetricians and Gynecologists, a self-interested and rather uninformed trade organization, not a scientific research group) has had to admit this.
There are definitely certain circumstances that indicate a more interventive birth or closer access to medical equipment that is only available in the hospital setting. There are certain pregnancy complications or preexisting health conditions that make out-of-hospital birth less safe. Some conditions have little to do with safety, but rather depend on policy. Different midwives vary in their policies (based on skill, experience, comfort level, and legalities) regarding breech or multiple deliveries and even VBAC. The reality is that most pregnancies are relatively healthy and most are uncomplicated, therefore most are not “too high-risk” to give birth at home if that is the families preference.
When I first meet with a potential client for a consult, not only are they interviewing me to see if they’d like me to be their care provider, I am also deciding if I think they would be a good candidate for a homebirth.
Obstetric history and overall current health: Do they have any predicting conditions that would require collaborative or complimentary care, and do I have those resources for her?
Family structure and dynamic: Do they have a good support network? Are there any negative influences on their confidence in their ability to birth, breastfeed, or parent? How are these influences handled? Is their partner supportive of them and trusting in their ability to make the best decisions for their body and baby?
How healthy of a lifestyle do they lead?: Will they take responsibility for eating well, exercising, and resting enough? How do they deal with stress? What resources do they have? What is their diet/nutrition?
What is their philosophy about their own health in general, and also pregnancy and birth specifically? One of the hallmarks of midwifery care is that we are guides or consultants, but ultimately, the client has to be willing to own responsibility for their own decisions. Informed consent does not mean trusting the Midwife. I want clients who are open to my input and recommendations but I never want clients who are passive and want to hand over all decisions to their care provider. I expect that families in my care inform themselves beyond what I provide and make their own decisions.
Location: Where do they live, how long will it take me to get to the home? How far is the nearest hospital? Is the home environment appropriate? Home birth can happen in small, close quarters, and while the home doesn't not need to be immaculate or sterile, it should be safe and comfortable. Exits should be clear and clutter kept to a minimum.
Every client has their own unique history and situation, and therefore it’s impossible to list all of the potential factors that come into play in deciding where and with whom they should give birth, but this is a nice way to scratch the surface and provoke more thought.
If you are considering midwifery care and homebirth, and wondering if you’re a good candidate, I suggest you think about how the above questions apply to you. That decision is about a lot more than just what you weigh, how old you are, or how your last delivery went. I offer free consultation visits, where you can meet and get your questions answered, and assess whether you’re a better candidate for home or hospital birth.