Planning a Safe Homebirth
For women with full term, head down singleton babies where mom and baby are both healthy, home birth with a qualified attendant can be a safe choice to make. However, because of the basic risks involved with not being in a hospital settings if serious complications occur, there are some critical issues to look at when planning your home birth, both in terms of choice of midwife and in terms of how to plan your birth in ways that minimize risk. As a mom planning a 4th birth at home, here is how I make sure that I am planning home birth in the safest manner possible.
Midwife:
Bottom line: if your midwife doesn't cut it, you are not safe at home. End of story. If you cannot find a good enough midwife, hospital birth is the safest and most responsible choice even if it's not the setting you prefer. Keep an open mind and high standards, and remember that a solid attendant matters more than being in the home setting. Here are things to consider:
1. Education: Education matters. It does. All of the studies demonstrating that home birth is a reasonable option are from countries where midwives have university education and are able to practice in either home or hospital settings. If your midwife is not educated enough to be able to practice in any other first world country, look elsewhere. This is the person you are entrusting your life and your baby's life to; it's ok to say that the person responsible for safety in your birth should at least have a bachelor's level of education in midwifery. You don't feel guilty about expecting college education from your child's teacher, and shouldn't feel guilty or unreasonable about expecting it from the person you are hiring for your birth.
2. Experience: Without a high enough volume of births, your midwife will not have seen enough to recognize complications before they have the chance to spiral out of control. You don't want to be your midwife's first placental abruption or first encounter with respiratory distress in an infant. I take this a step further and will not choose a midwife without extensive hospital based experience. Women with complications are rightly in hospitals, and I want a midwife who has seen the worst that nature can throw at birth so that she has a better chance of recognizing a pattern of a complication that leads to an emergency when minutes are brain cells and can be the difference between life and death.
3. Practice: How your midwife practices will tell you a lot about whether she is a safe attendant for you to plan home birth with. For example:
* Does your midwife carry malpractice insurance? If not, there needs to be a very good, verifiable reason.
* How many clients is your midwife willing to take on in any given month? Too few births and she maybe out of practice, too many and she could be so exhausted and burned out that she could miss the early signs of problems or could miss your birth entirely.
* How smoothly does her practice run? Are appointments timely? Lab results readily available to you?
* Who else attends your birth? Do not under any circumstances give birth with a midwife who is willing to attend you without a second trained set of hands in case both mother and baby are experiencing complications at the same time. My preference is for the assistant to be a registered nurse, and the midwife and assistant should know eachother and work well enough together as a team to provide seamless care in emergency situations.
* Does your midwife have oxygen, IV fluids, antibiotics to treat for Group B Strep, medications to treat bleeding, and other equipment necessary in an emergency?
4. Integrity and Professionalism: Your provider's good character is your defense against unethical care. Here are things to consider:
* What do other medical professionals in your area think about your midwife? Do they feel comfortable collaborating with her when clients need more advanced care outside her scope of practice, or refer patients seeking home birth to her?
* Is your midwife willing to lie or violate professional standards of care in her care? Is she willing to lie about performing tests or about their results?
* Verify that your midwife's license is in good standing, and that she participates in peer review.
* Find out what continuing education your midwife participates in.
* Google your midwife and see what people are saying about her online. Many more cautious midwives can be unfairly described online as "medwives," and it's worth raising any complaints you find that concern you with your midwife to gauge her response.
* Look at your midwife's social media presence and how it lines up with HIPAA requirements. Your protected health information should stay protected and not be spread all over your midwife's Facebook page.
For women with full term, head down singleton babies where mom and baby are both healthy, home birth with a qualified attendant can be a safe choice to make. However, because of the basic risks involved with not being in a hospital settings if serious complications occur, there are some critical issues to look at when planning your home birth, both in terms of choice of midwife and in terms of how to plan your birth in ways that minimize risk. As a mom planning a 4th birth at home, here is how I make sure that I am planning home birth in the safest manner possible.
Midwife:
Bottom line: if your midwife doesn't cut it, you are not safe at home. End of story. If you cannot find a good enough midwife, hospital birth is the safest and most responsible choice even if it's not the setting you prefer. Keep an open mind and high standards, and remember that a solid attendant matters more than being in the home setting. Here are things to consider:
1. Education: Education matters. It does. All of the studies demonstrating that home birth is a reasonable option are from countries where midwives have university education and are able to practice in either home or hospital settings. If your midwife is not educated enough to be able to practice in any other first world country, look elsewhere. This is the person you are entrusting your life and your baby's life to; it's ok to say that the person responsible for safety in your birth should at least have a bachelor's level of education in midwifery. You don't feel guilty about expecting college education from your child's teacher, and shouldn't feel guilty or unreasonable about expecting it from the person you are hiring for your birth.
2. Experience: Without a high enough volume of births, your midwife will not have seen enough to recognize complications before they have the chance to spiral out of control. You don't want to be your midwife's first placental abruption or first encounter with respiratory distress in an infant. I take this a step further and will not choose a midwife without extensive hospital based experience. Women with complications are rightly in hospitals, and I want a midwife who has seen the worst that nature can throw at birth so that she has a better chance of recognizing a pattern of a complication that leads to an emergency when minutes are brain cells and can be the difference between life and death.
3. Practice: How your midwife practices will tell you a lot about whether she is a safe attendant for you to plan home birth with. For example:
* Does your midwife carry malpractice insurance? If not, there needs to be a very good, verifiable reason.
* How many clients is your midwife willing to take on in any given month? Too few births and she maybe out of practice, too many and she could be so exhausted and burned out that she could miss the early signs of problems or could miss your birth entirely.
* How smoothly does her practice run? Are appointments timely? Lab results readily available to you?
* Who else attends your birth? Do not under any circumstances give birth with a midwife who is willing to attend you without a second trained set of hands in case both mother and baby are experiencing complications at the same time. My preference is for the assistant to be a registered nurse, and the midwife and assistant should know eachother and work well enough together as a team to provide seamless care in emergency situations.
* Does your midwife have oxygen, IV fluids, antibiotics to treat for Group B Strep, medications to treat bleeding, and other equipment necessary in an emergency?
4. Integrity and Professionalism: Your provider's good character is your defense against unethical care. Here are things to consider:
* What do other medical professionals in your area think about your midwife? Do they feel comfortable collaborating with her when clients need more advanced care outside her scope of practice, or refer patients seeking home birth to her?
* Is your midwife willing to lie or violate professional standards of care in her care? Is she willing to lie about performing tests or about their results?
* Verify that your midwife's license is in good standing, and that she participates in peer review.
* Find out what continuing education your midwife participates in.
* Google your midwife and see what people are saying about her online. Many more cautious midwives can be unfairly described online as "medwives," and it's worth raising any complaints you find that concern you with your midwife to gauge her response.
* Look at your midwife's social media presence and how it lines up with HIPAA requirements. Your protected health information should stay protected and not be spread all over your midwife's Facebook page.
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