Brittany Sharpe McCollum of Blossoming Bellies Wholistic Birth Services shares her advice for families considering homebirth as an option.
As pregnant individuals and couples become more informed and take greater responsibility in their expectations and standards for birth, more people are considering homebirth. In 2004 the rate of homebirth was at its lowest, at .56%, but the current national rate has risen to anywhere from .9% according to the American College of Obstetricians and Gynecologists, to 1.36% according to 2012 data from the CDC, with approximately three fourths of these births being planned homebirths attended by a midwife. The numbers are still small but there is a clear rise in the desire for informed and educated homebirth. Having the option to birth in a hospital, in a free-standing birth center, or at home is a crucial part of optimal healthcare and is an important part of the empowerment that comes from making choices that are best for each individual family. If homebirth is an option you are considering, here are some points to discuss when making your decision.
What are my own philosophies about birth? Figuring out where you feel safest in birthing your baby is at the heart of choosing the best birthing location for you. According to Birth Works International, a childbirth educator and doula certifying organization, women will labor the best where they feel safest and most secure. For some this is a hospital, for others it’s a birthing center, and for others it is at home. Exploring your own thoughts, and those of your partner if applicable, regarding the role of interventions in birth, desire or lack of desire for pain medication, and the ideal birthing environment will help you figure out what setting feels best
With which type of midwifery care would I feel most comfortable? Midwifery care is the most common option for those considering homebirth. The options for midwifery care include a CNM (Certified Nurse Midwife), CM (Certified Midwife), CPM (Certified Professional Midwife), or lay midwife. A CNM is a registered nurse with education in both nursing and midwifery. A CM is a credential that is very similar to the CNM; they have received education in a health-related field other than nursing but have completed the same certification exam as and have a scope of practice similar to a CNM. A CPM has completed three to five years of academic and clinical training either through self-study and apprenticeship or an accredited education program and has passed a board exam. A lay midwife may have completed apprenticeship and may have completed additional classes or education. This midwife either chooses not to certify or certification is not available in the state of practice. Direct-entry midwives includes CMs, CPMs, and lay midwives and basically means that a nursing degree was not part of their path to midwifery. Many states regulate homebirth midwifery through licensure, certification, or registration with the state. In some states, the practice of direct-entry midwifery is illegal.
Check out MANA (Midwives Alliance of North America), ACNM (American College of Nurse-Midwives), and NACPM (National Association of Certified Professional Midwives) for additional information regarding the paths to becoming a midwife and the legal aspects of homebirth midwifery from state to state. Understanding the different types of training and qualifications and choosing a provider whom has the background and philosophy with which you feel most comfortable is important yet without national credentialing, this can be tricky. Discussing the meaning of your midwife’s certification and how that will impact their practice’s policies and procedures surrounding intervention and hospital transfer will help you get a well-rounded idea of what can be expected from their care.
Will my insurance cover the cost of my maternity care? insurance coverage for homebirth varies from one insurance plan to another and varies from one type of midwifery care to another. In order to understand the financial obligations of birthing at home, it is advised that one talk with their potential midwife about the cost of services and further discuss insurance coverage with the insurance provider. The midwife is not under any obligation to provide services at free or reduced cost; the sole responsibility of understanding payment obligations and providing payment for the birth is on the recipient of care.
How will I obtain prenatal care prior to the birth? Homebirth midwifery care includes most common prenatal testing, monthly prenatal visits through week 28 of pregnancy, visits every two weeks from 28 until 36 weeks, then weekly visits from 36 weeks til birth, clinical support through labor and birth, the newborn exam immediately following birth, and several in-home postpartum follow-up visits, as well as a visit in the midwife’s office six weeks after birth.
Does my midwife have a larger community of which I can be a part? Some families find that the support of a larger community of individuals making similar choices is helpful throughout pregnancy and the transition into the role of a parent. Ask your potential midwives if they offer any online support groups or in-person get-togethers or can refer you to other community resources that do (such as play spaces, parenting centers, childbirth classes, doulas, etc.).
How will I become as educated as possible about the labor process? Finding a childbirth class that is geared towards homebirthing families or an educator whom is familiar with the homebirth process can offer enormous support, education, and information about what homebirth looks like, the role of the provider and any support people present, possible reasons for transfer to the hospital, the postpartum period and how best to be supported, and more. Childbirth classes can also lead to the development of questions that can be brought to the midwife at prenatal visits. Often general childbirth classes can accommodate the needs of those birthing in hospitals, birth centers, and home but it can be helpful to check with the educator first to gauge her comfort level and professional experience with homebirth.
What type of additional support will I need to feel as comfortable as possible? Many families birthing at home will choose to have additional support present such as a doula or a family member or friend. Midwives are present for the clinical care and safety of the birthing person and the baby; additional emotional or physical support can be a positive asset to the birthing environment. If you have an older child at home that will possibly be present for the birth, procuring support for them is important (such as a grandparent, aunt or uncle, or close friend of the family with whom they are comfortable). Many midwives also request that expectant couples have back-up care in place with a local hospital. This can be discussed further with the midwife whom you choose.
How will I respond to questions from family and friends? This brings us back to having a firm understanding of one’s own philosophies and motivations for choosing homebirth. Research can be an important part of making the choice to birth at home but is not the only aspect of choice to consider. Many will feel comfortable voicing their reasons for homebirth to questioning family members or friends while others may feel more comfortable keeping their choices and reasons to themselves. Putting some thought into how you will handle questions that may come up is important for continuing to have confidence in your choice while also preparing you to deal with the well-intended concerns that may come up from those whom have not considered homebirth or have pre-conceived notions of what homebirth looks like. Educating oneself is crucial for taking responsibility for one’s own health and healthcare options and being prepared to talk with naysayers can be a catalyst for deeper understanding and empowerment.
Homebirth provides an opportunity for families to create a space that is all their own and to have shared decision making with their provider in an intimate environment. For some the choice to birth at home is an empowering and exciting option that allows them a sense of peace and control over the process. Choosing the place where one will give birth is a decision that will vary from one person or family to the next. Being in a space where one feels safe, supported, and able to be vulnerable is key to relaxing both physically and mentally and allowing the process to unfold as calmly as possible, whether this be hospital, birth center, or home.
A big thank you to Christy Santoro, CPM, and owner of Motherland Midwifery, for help clarifying the different options for midwifery care.
Cohen, Jill. “The Homebirth Choice” Midwifery Today,
MacDorman MF, Mathews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990–2012. NCHS data brief, no 144. Hyattsville, MD: National Center for Health Statistics. 2014.
Planned home birth. Committee Opinion No. 697. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e117–22.
Sifferlin, Alexandra. “Explaining the Latest Numbers on Home Births.” Time
Brittany Sharpe McCollum, CCE(BWI), CD(DONA) is the owner of Blossoming Bellies Wholistic Birth Services, providing childbirth education, doula services, workshops for expectant parents, breastfeeding classes and support, infant and toddler nutrition classes, doula training and mentorship opportunities, and pelvic bodywork workshops for birth professionals from doulas to childbirth educators to midwives, nurses, and OBs in the greater Philadelphia area. Her classes can be found in South Philadelphia, Fairmount, Fishtown, West Philly, Mt. Airy, and Collingswood, NJ. Brittany began Blossoming Bellies in 2006, after the birth of her first son left her feeling that there was a great need for women and their partners to be empowered and confident in their births while finding the resources and education in the community to support that. She encourages women and their partners to explore their birthing options, to be aware of their rights, and to be empowered to make informed, evidence-based decisions throughout the childbearing year. Brittany lives in South Philadelphia with her husband, two sons, and daughter. For more information about Brittany and her her services, check out her website and follow Blossoming Bellies on Facebook and Instagram.