Frequently Asked Questions (FAQs)

Safety is of importance to us…We think that midwives are skilled at blending both nurturing supportive care and appropriate technology to insure safe and normal birth. Plenty of research supports this.

Studies about planned home birth and birth center birth in the medical literature uniformly report outcomes equivalent or superior to those of comparable women giving birth in the hospital.

In 2005, the British Medical Journal published a study of 5418 planned home births which once again concluded that this is a safe option for low risk (healthy) women. The study confirmed that home birth with midwives was associated with lower rates of medical intervention, while maintaining similar intrapartum and neonatal mortality as that of hospital birth for low-risk women.

Fullerton and Severino report in a 1992 study published in the Journal of Nurse Midwifery that:

“[Low risk] women in hospital were more likely to receive an interventive style of labor and birth management. Neonatal outcomes were similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage for low risk women, and it was associated with increased intervention.”1

There are many studies exploring this issue of safety and homebirth. One of the largest, involving over 24,000 births, compared the safety of planned homebirth with planned hospital birth for low-risk women.2 This study compared several outcomes, the main ones being infant and maternal mortality. There was no difference between the two groups in either infant or maternal mortality. However, “Approximately twice as many babies in the hospital group as in the home birth group had low Apgar scores.” Apgar scores are a measure of a baby’s well being in the first few minutes of life. Episiotomies (an incision done to enlarge the vaginal opening at the time of birth) are an intervention that is often done in hospitals. This is true, despite the fact that they frequently lead to more severe lacerations and that they do not improve outcomes. In Olsen’s study, there were 50% more perineal lacerations among the women who delivered in hospitals.

One of the main reasons for homebirth’s good track record is that midwives have the flexibility to be patient and wait for the woman to give birth at her own pace. Midwives are not held to tight time constraints, and consequently are not tempted to rush the process of birth. This simple act of waiting patiently for the birth to unfold prevents the need for many interventions that can themselves cause the baby or mom to develop “complications.” Midwives combine the art of waiting and watching with careful monitoring of the mom and baby to ensure that the birth progresses normally.

Of course! We do many waterbirths and we have several tubs available to use for your labor whether you plan to deliver in water or not. It is difficult (if not impossible) to know how you will feel when you are in labor. Some women who adore the water find that they do NOT like it in labor or they might love it. Others who have no particular attraction to water find it to be a great relief in labor or delivery. For the majority of women it offers significant comfort and relief which is why we recommend it.

In California and many other states, there are two types of midwives:  Certified Nurse-Midwives and Licensed Midwives.  A Certified Nurse-Midwife (CNM) is a Registered Nurse with a Master’s Degree of Midwifery and who is licensed by the Board of Registered Nursing.  A California Licensed Midwife (LM) is held to the same standards and body of knowledge as a CNM but is licensed by the Medical Board of California and does not write prescriptions for allopathic medications.   Some Licensed Midwives are also Registered Nurses but most enter the midwifery profession directly as per the European and Canadian model of midwifery.

Women choose to have their babies at home for various reasons, but some of the most common reasons we hear are the following:

• Desire for a natural birth
• More control and choice in who is there, where to labor, what position to labor in, whether to eat and drink, etc.
• Security and comfort of own home and belongings
• Less anxiety and stress
• Immediate close contact with the new baby
• Not attached to machines and IV poles
• Greater sense of being able to let labor to progress naturally
• Fewer interventions like epidurals, episiotomies, forceps/ vacuums, and unnecessary IVs
• Lower risk of having an unnecessary cesarean
• More family unity
• Lower cost
• Less exposure to hospital bacteria and other germs
• Higher satisfaction level

• Sterile instruments for the birth and cutting the umbilical cord
• An oxygen tank and resuscitation bag/ masks for mother and newborn
• A suction device for removing mucus and other material from the baby’s nose and mouth
• A stethoscope for listening to the baby’s heart rate during labor and pushing
• Drugs and/or herbs for preventing or stopping the mother from bleeding too much after the birth
• IV equipment and fluids for rehydration of the mother
• Vitamin K and eye ointment for the newborn

Most women with low-risk, healthy pregnancies can have a home birth.  Risk criteria vary from state to state, but in most places, a woman is no longer considered to be “low-risk” if any of the following occurrences happen in the prenatal period, during labor, or immediately postpartum:

• The mother has any abnormal bleeding
• The mother is Rh-negative and has become sensitized to Rh-positive antigens
• The mother has high blood pressure requiring medication
• The mother has pre-existing diabetes (this is different from “gestational diabetes”)
• The mother has heart, kidney or lung disease
• The mother is a heavy alcohol or drug user (or anyone else in the home that may be considered a risk to the midwife or emergency personnel during labor, birth and the immediate postpartum)
• The mother develops pre-eclampsia
• Labor begins before 36 weeks of pregnancy
• The mother has severe anemia
• The baby’s umbilical cord prolapses when the water breaks
• The baby’s heartbeat indicates that it is distressed

This list may be different for the midwife that you choose and is not intended to be an exhaustive list of every reason.  If you have a question about whether you are a good candidate for a home birth, please contact us.

Sure!  If you are having a low-risk, healthy pregnancy, it doesn’t matter whether you are having your first baby or your tenth.  If you meet the following criteria, then you are probably eligible for a home birth:

• Is in good physical and mental health
• Has good nutritional status
• Has adequate social support before, during and after birth
• Is socially mature and able to accept responsibility for birth outcome
• Has a positive emotional environment
• Has access to childbirth, home birth and breastfeeding education (books, classes)
• Has access to emergency transportation
• Has a clean home and birthing room, with electricity, running water and a working telephone
• Understands that technological intervention is used only when necessary
• Understands that pain medication will not be used during labor
• Agrees to transfer to the hospital during labor, birth or postpartum, if necessary

Many of our clients are first-time moms and have beautiful home births.  If you are interested in learning more, please contact us.

Yes, of course.  Many families like to commemorate the birth of their child by burying the placenta and planting a tree over it.  The placenta will nourish the growth of the tree, much like it nourished your baby in the womb.  Some new mothers choose to have the placenta dried and encapsulated, as taking the capsules may help with lactation and minimize fatigue and postpartum mood disorders.  Meghan Johnstone is a Placenta Encapsulation Specialist and can assist with this process.  Let your midwife know if you would like to keep the placenta, and she can wrap it up for you in a couple of plastic bags and put it in your freezer until you are ready to use it.  If you prefer not to keep the placenta, you can dispose of it.

There have been over 100,000 babies born in the water reported worldwide, and the research into the safety of waterbirth is still being done.  The main challenge in doing research on waterbirth is that women typically choose whether to labor and birth their babies in the water, just like women choose home birth, and it is often difficult to know if women who choose waterbirth are different from women who choose other methods of birth in ways that can affect the research outcomes (i.e., they may be in general older, having their second or third babies instead of their first, are better educated about birth, have better nutrition, fewer smokers, etc.).  These factors can overlap each other and make it difficult to see whether the outcomes are better or worse because of those things or because of the fact that they were in the water.  So researchers are still conducting studies to pin down whether there are any differences in outcomes between babies born in water and babies born on land.

Many of our clients choose to have a waterbirth at home.  Some mothers find that they just like to labor in the water because it seems to make the contractions much easier to handle.  The midwife can monitor the baby’s heartbeat regularly in the water with a special waterproof stethoscope.  If you choose to have your baby in the water, the midwife will help you to bring your baby up out of the water and gently into your arms within a few seconds after s/he comes out.  Until babies come in contact with air, they receive all of their oxygen through the umbilical cord, just like they do throughout the entire pregnancy.  For a great explanation of how this amazing process works in the newborn and why they don’t inhale water when they are born, see “What Prevents Baby From Breathing Underwater” by Barbara Harper.