Just as in the case of last week’s question about natural birth in the hospital, there isn’t one simple answer to the question of whether you can have a home birth. Generally speaking, home birth with a qualified medical attendant is a safe option for low-risk birthing individuals. The definitions of qualified attendant and low-risk vary depending on whom you ask. As doulas, it’s our job to help you sort through this information by providing referrals to medical attendants whom we trust. We also listen to your fears, concerns and desires to support your decision-making process. And as always just a quick disclaimer: Doulas do not provide any medical advice. Always consult your care provider for information pertaining to your own health and your pregnancy. Here are some key points to consider:

1. Who will provide your medical care? Since doulas are not midwives, you’ll want to make sure you have both a midwife and a doula you feel comfortable with. The midwife makes sure you and your baby are safe medically speaking. The doula makes sure you and your baby are well cared for by providing emotional and physical support. There are different types of midwife licenses. Certified nurse midwives are licensed in all 50 states to attend births in the home or hospital. Certified professional midwives are licensed for home birth only in some states. So the training and certification for these two licensures are different.
2. What will be the cost? Midwives are sometimes able to take certain forms of insurance directly. For other arrangements, you’ll need to pay out of pocket and see if you can get reimbursement from your insurance company. Many midwives are able to provide payment plans, especially if you are seeking care early in your pregnancy.
3. What other forms of support do I have? Midwives need to focus on clinical care. So while they are often excellent at nurturing your mind, body and spirit, too, it’s very beneficial to identify several other forms of trustworthy support. Seek doula care, talk with your family and other members of your support system. If they’re not willing or able to support your plans for a home birth, you might need to find a way to gently release them from their role as a birthing partner.
4. What is the plan if transferring care is necessary? In some cases, a low-risk pregnancy morphs into a higher risk birthing scenario. Intra-partum (during labor) transfers to the hospital usually occur long before the concern becomes a true emergency. An example might be a fever that develops or a concerning heart rate pattern for the baby during labor. The majority of problems that cause pregnancy to become high-risk are detected before labor begins, such as gestational diabetes, pre-eclampsia, prologned pregnancy (42 completed weeks), breech positioning, or intra-uterine growth restriction (IUGR). If transfer to a hospital is necessary, in most cases your home birth midwife will not be able to transfer with you. The midwife will make a seamless transfer of care to a hospital-based provider, and then your doula will accompany you to the hospital.

As I’m sure you know, birth will never carry zero risk factors. It is possible for a complication to spring up out of nowhere. However, you can rest assured that with a healthy pregnancy, a skilled midwife, and the care of at least one additional support person, you’ll be in good hands. And you just might be able to answer the question: can I have a home birth with YES, I can!