To have your baby at home, you need to be under the care of a midwife, or you have chosen to have a free birth/unassisted birth. Doctors do not attend out-of-hospital (OOH) births in the United States. If under the care of a midwife, your pregnancy must be considered medically low-risk in order to birth at home. This is something that is determined prenatally.
When having a home birth, there are things to consider and prepare for that are specific to having your baby outside of the hospital.
There are supplies to order and gather (your midwife will inform you of what you need, but it includes: a birth kit, tinctures and herbs you may need/want postpartum, a birth pool or liner, towels, sheets, etc.), and if you have other children, it’s good to make a few contingency plans so that in the birthing moment, everyone is taken care of.
Once all the bigger details are taken care of (or even if they’re not), settle in to your last weeks of pregnancy. Unlike obstetric care, many midwives will not encourage induction for non-medical reasons at or before 40-42 weeks, so it’s a good idea to get comfortable with not knowing, and practicing patience (one way or another, all babies do come out.) Remember, “due” dates are an estimate!
In preparation for labor, it’s good to stock your refrigerator, freezer, and pantry with foods to eat in early labor (proteins and carbohydrates), in active labor (fruits, smoothies, toast, foods that are simple and easy to digest, electrolyte drinks such as labor-ade or Recharge, etc.), and for postpartum (you will be very hungry after you have your baby). In the hospital setting eating is not permitted, however at home it is encouraged. Having a baby takes a lot of effort, and eating small amounts throughout labor will help you reach the finish line!
Generally speaking, your midwife will arrive once you are in active labor (when contractions are 3-5 minutes apart, although when they arrive can vary based on your particular needs, your specific birth history, which number pregnancy this is, etc). Most midwives bring plenty of things along, such as: oxygen and resuscitation equipment, medications in the event of hemorrhage, herbs and homeopathics (covering a wide range of indications), a birth chair, birth pool, among other things. Throughout labor the baby is assessed using ‘intermittent auscultation’ (as opposed to continuous fetal monitoring, as is done in the hospital). This allows you to move freely and labor in different positions and locations all of which facilitates the birthing process. The actual location of your birth can vary, as well. Some positions or places may be in the birth pool, on your bed, on hands & knees, standing, on the birth chair, etc. Sometimes many positions and places are tried over many hours, or on other occasions baby comes quickly! Every birth unfolds differently.
Once your baby is born, next we await the placenta. There are two approaches to placental management: 1) active and 2) expectant. In the hospital and among some midwives “active” is practiced. This involves a shot of Pitocin after the shoulders are birthed to encourage the contracting of the uterus and the expulsion of the placenta. Cord traction is then used to deliver the placenta in a timely manner. “Expectant” management is a less aggressive approach where the body releases the placenta on its own time (generally within 5-45 minutes) or using gentle cord traction. Upright positions, herbs and homeopathics can help encourage a spontaneous expulsion, should it be needed.
Once the placenta is delivered, the cord is generally left intact so baby receives the benefits of delayed cord clamping. When all is stable, mama, baby, and partner are left to explore and get to know each other and establish breast/chestfeeding. This sweet undisturbed time is known as the “Golden Hour” and is critical for an optimal hormonal exchange and bonding. Once this has happened, the newborn exam is performed generally at the foot of the bed. The baby never leaves the room or your line of sight.
Midwives are trained to identify deviations from normal, so if transfer to the hospital is ever indicated either during the labor or postpartum, it is initiated.
Finally, rest assured that most midwives will clean up after the birth. The birth pool will be taken down and put away, laundry will be started; the space should look mostly like it did before your labor started, allowing you and your family to nestle and focus on the newest and sweetest addition to your family.
Home birth is not for everyone. And certainly, there are situations and circumstances when the hospital is the best and safest choice. But for many individuals and families, home birth is the best option resulting in the least amount of interventions for this most natural and normal event.
Birth: every home should have one.
Ulrike Schmidt, CPM; LM, Heart of Gold Midwifery
After the birth of her second daughter (both of my daughters were born into the capable and loving hands of midwives), inspiration struck for Ulrike. She began the Midwifery Training Program through the Association of Texas Midwives in 2012, completing the program and her apprenticeship at the tail end of 2016, graduating and becoming licensed in early 2017. Ulrike trained for 4.5 years under a single preceptor who has been a midwife for almost 35 years. During her training, she attended approximately 115 births. Ulrike is a Licensed Midwife (LM) and Certified Professional Midwife (CPM) (2017), through NARM (National Association of Registered Midwives). She is a registered member of the Association of Texas Midwives and is certified in both CPR and Neonatal Resuscitation. Ulrike received her B.A. in Anthropology from Drew University in 2000.