I want a home birth.

Congratulations on your pregnancy. Whether you are a first time parent or a second time parent, you can have a home birth. For many pregnant women giving birth in your own home is the pinnacle of Life’s success.  Birthing at home has so many wonderful, wonderful qualities. And as a woman who is making the choice to have a home birth, you are really taking responsibility for all the necessary preparations for giving birth.  You’ve chosen carefully who your midwife will be and perhaps your doula. You’ve gone through the list of who you’d like there. You’ve made certain to stock your freezer with foods and make arrangements for the kids you might already have. You’ve gotten all the supplies in your home birth preparations kit. Is there anything left out?

Should I consider a home birth?

If you're a healthy expectant mother having a normal pregnancy and you have no medical or obstetrical risk factors, giving birth at home may be an option for you.

Giving birth at home allows you to labor and deliver in familiar and comfortable surroundings. You'll have more control over your birth experience than you would in a hospital, and you won't have to endure routine medical interventions.

At home, as many family members or friends as you want can attend the birth, and you get to share the experience with them in the privacy of your own home, without interruptions from hospital staff. And all of your caregiver's attention will be focused on you and your baby. Giving birth at home isn't for everyone, of course. Moms-to-be who are more likely to have complications during childbirth should give birth in a hospital. This includes women with:

Medical conditions, such as high blood pressure or diabetes, a previous c-section or other uterine surgeries, Pregnancy complications, such as premature labor, preeclampsia, twins (or more), or a baby in the breech position at 37 weeks

If you choose to have a home birth, it's important to be flexible and understand that if complications arise, you might have to transfer your care to another provider or give birth in a hospital. You'll also need to be committed to giving birth without medication, preparing your home for the birth (including getting whatever supplies your caregiver recommends), and making plans to ensure that you have good support available to you in the days after you give birth.

Another consideration: Not all insurance companies and HMOs cover the cost of home births. Although most insurance companies are now covering doula and midwife costs, you will need to reconfirm with your insurance provider.

Is giving birth at home safe?

For healthy women at low risk for complications who choose skilled and experienced caregivers and have a good system in place for transfer to a hospital when necessary, a number of studies show that giving birth at home is just as safe as giving birth in a hospital. There is also research showing that moms who planned to give birth at home (regardless of where they actually had their babies) ended up with fewer interventions, such as episiotomies and c-sections, compared with a group of equally low-risk women who had planned hospital deliveries. But home birth remains controversial in the United States. The American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) oppose home birth. They contend that the hospital is the safest place to give birth because capabilities of the hospital setting and the expertise of the hospital staff are immediately available if a complication arises suddenly.

On the other hand, both the American College of Nurse-Midwives and the Governing Council of the American Public Health Association support the choice of women who are good candidates to give birth at home. They say that qualified caregivers, along with appropriate arrangements for backup and transfer, should be available for moms-to-be who want this option.

What else can I do to make sure that my home birth is as safe as it can be?

Find a good practitioner

Look for a certified nurse-midwife (CNM), a certified direct-entry midwife (CPM or CM), or a physician with plenty of experience delivering babies at home. Ask about her education, her credentials, and whether she's licensed to practice in your state.

Be sure your caregiver carries the necessary equipment and supplies to start emergency treatment if needed, such as infant resuscitation equipment and oxygen, IVs, and medication to stem postpartum bleeding. It's also critical to make sure that she has an arrangement for backup with a qualified doctor and a nearby hospital in case you need to be transferred.

Make sure your backup plan is solid

Make sure the backup hospital is relatively close and that your transportation there is fail-safe in case something goes wrong and you need to get to a hospital quickly.

Find a supportive doctor for your baby

Establish a relationship in advance with a pediatrician or family doctor (or group of doctors) in your community who'll be able to see your baby a day or two after he's born and is, ideally, supportive of your choice to deliver at home. (Your caregiver should be able to recommend one.)

Hire a Birth Doula.

Birth Doulas provide physical, and emotional support through pregnancy, labor and childbirth. A doula won’t leave at shift change….even if your labor progresses through more than one shift change. It’s incredible to think that, isn’t it? That someone will be there through the entire experience, no matter how long it takes, because you need them to be. The art of being a doula is one that takes incredible sacrifice sometimes, but it’s always done out of love and concern for you and for baby. There’s nothing like it. Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With their support, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience. Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40%, and requests for an epidural by 60% .

Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream (causing uterine contractions) and to the brain (resulting in feelings of well-being and drowsiness, along with a higher pain threshold).

Historically it was thought that intravenous oxytocin does not cross from the bloodstream into the brain in substantial amounts and, therefore, does not provide the same psychological benefits as natural oxytocin. However, more recent studies indicate that oxytocin administered nasally and/or intravenously may cross from the bloodstream into the brain. Nonetheless, doulas can help mothers experience the benefits of oxytocin naturally without the use of medication.

Are doulas only useful if planning an unmedicated birth?

The presence of a doula can be beneficial no matter what type of birth you are planning. Many women report needing fewer interventions when they have one. But be aware that the primary role of the doula is to help mothers have a safe and pleasant birth–not to help them choose the type of birth. For women who have decided to have a medicated birth, the doula will provide emotional, informational, and physical support through labor and the administration of medications. Doulas work alongside medicated mothers to help them deal with potential side effects. Doulas may also help with other needs where medication may be inadequate because even with medication, there is likely to be some degree of discomfort.

For a mother facing a cesarean, a doula can be helpful by providing constant support and encouragement. Often a cesarean results from an unexpected situation leaving a mother feeling unprepared, disappointed, and lonely. A doula can be attentive to the mother at all times throughout the cesarean, letting her know what is going on throughout the procedure. This can free the partner to attend to the baby and accompany the newborn to the nursery if there are complications.

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Owings Mills, Maryland 21117


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