What are your risk factors?
You may have heard it before; homebirth is a good option if you are “low-risk.” But how do we determine who qualifies as low-risk?
In Florida, midwives have a list of risk factors to consider with each client before being accepted into care. Assessment of risk factors is legally required for a homebirth.
Risk factors range from 1-3 points based on severity, with one being the lowest.
Anyone with a total score of 3 or higher will need an OB’s approval to continue midwifery care. If the OB approves, and the midwife agrees to continue care for the client given the assumed risks, the plan to continue with a homebirth may continue. If the risks are too high, the OB will advise the client towards the appropriate care.
Here is the form I use that is review risk status with clients considering midwifery care
You may not understand everything on the list, but your midwife will obtain a complete health history and perform routine tests during the pregnancy to determine if these risk factors apply to your care.
There may be other risk factors present that are not listed. For example, risks can include being pregnant with multiples, which licensed midwives cannot deliver. In these cases, it is at your midwife’s discretion to determine the next course of action. Possible actions range from no additional risk to advising care with a high-risk OB.
Can you use your home?
Now that you understand how risk is determined, what factors do you need to consider with your home?
The number one requirement is that your home must be within 30 minutes of a hospital with obstetric and neonatal intensive care services. If you live in the city or surrounding suburbs, this is very likely, but a midwife will discuss this with you if you are unsure.
Another requirement is that you have running water, electricity, and general cleanliness. Not a sterile environment, bacteria are a normal part of daily life, and the risk of infection is lower with homebirths. Additionally, you are not required to have a house with a yard and a white picket fence; homebirth occurs wherever you call home, be it an apartment, condo, bungalow, or trailer.
If your home is not close enough to a hospital, delivering at a birth center birth might be advised and offers a similar experience. If a birth center is not available, there may be other options for your situation -like delivering at the home of a family member closer to a hospital- so speak to a midwife. They may have a solution to help.
The next consideration is not a requirement but a good guideline. Consider who is in the home. Are you living with family or roommates? Are you comfortable delivering with them nearby? Are they comfortable with you delivering at home? Who in the home will support you during your labor? Just as important, who will care for you -and the house- after the birth? Bed rest is advised for the first two weeks or a minimum of the first 24 hours. Meaning you need to have someone who will oversee cooking, cleaning, and taking care of any other children in the house, preferably for the first two weeks following delivery.
This last consideration may feel like an obvious one: planning a homebirth will involve no pain medication. It is not because midwives want to deny you this service. There are risks associated with pain medications, so the use of pain medications requires additional and continual monitoring, making the hospital the safest place for these to be administered.
Can you afford a homebirth?
Most midwives offer a self-pay rate, and this often varies anywhere from $5,000 to $7,500. Every midwife has different options/services included in their price. Some midwives include blood work, ultrasounds, medications, etc., while others may only offer those for an additional charge. However, the cost should cover your prenatal visits for the entire pregnancy, the labor/delivery, and postpartum care. Full payment is typically required by 36 weeks of pregnancy, so plan accordingly.
What about insurance or Medicaid? This topic can be an entirely separate post of its own; the bottom line is to ask your midwife. Some do accept these, and some do not. Midwives often want to take them. Unfortunately, many insurance companies usually either do not cover midwives or only pay a fraction of the fee.
Are there midwives who serve your area?
How do you find a midwife for a homebirth? It depends on where you live. Some areas have many midwives or group practices of midwives. Other areas have none, simply put, most midwives are on Google.
If you live in an area with a few midwives to choose from, it is a good idea to interview your top choices and choose who you trust the most. A trusting relationship is crucial to your birth. A trusting relationship means that you will trust your midwife’s guidance during your care, but it also means that your midwife will trust you to follow her guidance, and your midwife is also going to trust you when you feel otherwise. For example, if a midwife advises the client to transfer to the hospital, the client should trust the midwife’s judgment and transfer. The midwife also needs to trust the client not to risk their safety and willingly transfer. A trusting relationship also means if a client feels something is not right and wants to transfer, the midwife should respect their desire to transfer and support them during the process.
Are you ready?
There are many steps taken to ensure that homebirth is a safe option here in Florida, but no matter what kind of birth you choose, it is essential to research all the options available to you and choose what works best for your family.
Being a parent means making choices that you feel are best for your child. For example, you will make choices about dietary needs, schooling options, extra activities, etc. Every choice you make will have risks and benefits; these choices start with birth. The tricky part of making these decisions is often related to someone disagreeing with you. Educate yourself on your options, surround yourself with a supportive network, hire care providers that have earned your trust (and fire them if they break it), and get ready for the journey of a lifetime!
I initially started this blog while working overseas to keep my supporters updated, then I did it a time as a required assignment during my midwifery school, but now I write but because I want to. So now I share my current journeys, in hopes that others can learn from them, or at the least have a good laugh.