Midwifery & Home Birth FAQs

Midwifery is a healthcare discipline that focuses on caring for women throughout pregnancy, birth, and postpartum. Midwives aim to provide a personal and holistic approach to care, promoting natural and physiological birth processes whenever possible.

The midwife’s role involves the identification and management of normal pregnancy and birth processes, as well as the recognition and response to any deviations from normal. They can provide care in a range of settings, including homes, birth centers, and hospitals. Typically, midwives offer a range of primary care services to women, including well-woman gynecological exams, family planning, and menopausal care.

Midwives and obstetricians both play a crucial role in caring for women during pregnancy and childbirth, but their training, approach and scope of practice differ. Despite some similarities, there are key differences between the two:

One difference is their approach to care. Midwives have a more natural, woman-focused approach, striving for personalized care and giving women a voice in their own health and birth journey. Conversely, obstetricians are doctors with a more medical approach, focusing on identifying and treating any medical issues that may arise.

Their training and certification also differ. Midwives complete  graduate level education and receive a masters in Midwifery and Certification from the American Midwifery Certification Board. Obstetricians are medical doctors who complete a residency in Obstetrics and Gynecology and are licensed by state medical boards.

There are also differences in the setting of care. Midwives can provide care at homes, in birth centers, as well as the hospital, while obstetricians primarily work in hospitals and obstetrical clinics. Midwives are trained in managing normal pregnancy and birth processes and can perform medical interventions if necessary. On the other hand, Obstetricians are authorized to diagnose and treat medical complications that may arise and can perform surgery if needed.

A midwife’s role during a home birth is to offer complete prenatal, birth, and postpartum care to the mother and her family. This includes monitoring the mother’s health and pregnancy progress during prenatal visits, providing support and counseling, monitoring mom and baby’s safety in labor and delivery, and offering care and support post-birth.

In emergency situations, midwives are trained to transfer care to a hospital. The goal is to offer personalized care and ensure a safe and satisfactory birth experience.

According to the American College of Obstetricians and Gynecologists (ACOG), low-risk women can safely birth at home with a qualified midwife. Some studies have shown that home birth can be even safer than hospital birth for low-risk women, because there are fewer interventions.  Regardless of location, all births carry a degree of risk. To ensure a safe home birth, it is important to choose a qualified midwife and make informed decisions based on a thorough understanding of the risks and benefits.

Midwives are trained to identify any deviation from normal during labor and can take appropriate action in case of difficulties. They  can resolve complications during a home birth, such as changes in the baby’s heart rate, using non-invasive methods. If a problem arises that cannot be managed at home, the midwife will take necessary steps to guarantee the safety of the mother and baby via transfer to the hospital.  

The qualifications for a midwife to perform home births vary depending on the area. Midwives must generally fulfill certain educational and training standards and obtain a license from the state or province in which they operate. In the United States, midwives are divided into two main categories: Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs). CNMs are registered nurses who have finished a midwifery program at the graduate level and passed a national certification test. CMs, on the other hand, are midwives who have completed a graduate-level midwifery program but are not registered nurses. Continuous education and adherence to professional standards of practice are also mandatory for midwives, in addition to education and certification. Some states may have specific guidelines regarding home birth practices, such as the necessity of emergency equipment and medication or protocols for transferring care to a hospital during an emergency. 

The methods for managing pain during a home birth depends on the woman’s preferences. Some common techniques include hydration and positioning, relaxation and breathing, massage and touch, water therapy, and medications like nitrous oxide. It’s important to have a clear understanding of the available options and associated risks, and to discuss them with the midwife before the birth. 

The expense of having a home birth with the assistance of a midwife can differ based on multiple variables, such as location, midwife fees, and insurance coverage. Health insurance policies can cover some or all of the costs of a home birth with a midwife, however, this varies greatly depending on the insurance policy and location. 

Average Cost in New York

On average, the cost for a home birth in New York can range from $3,000 to $10,000 or more, though this can vary depending on individual circumstances. It is important to remember that there may still be additional expenses even with a home birth, such as prenatal care, tests and procedures, and postpartum care. Unexpected complications during labor and delivery may also lead to extra costs if a transfer to a hospital is necessary. The best way to determine the cost of a home birth in New York is by speaking directly with a midwife or midwifery practice in the area. They can provide you with more information on the services they offer and their associated costs.

When choosing a midwife for a home birth, several important factors should be considered: education and certification, experience, philosophy and approach, availability, communication and rapport, cost, and reviews. It’s essential to find a midwife who is properly trained and licensed, has experience with home births and a positive track record. She should align with your values and preferences and you should trust and feel comfortable with her. Consider the cost, payment and refund policies, and any additional expenses. Seek recommendations and read reviews before deciding. Trust and communication are the most important factors in choosing a midwife to ensure a positive birth experience and good outcomes.

Midwives are trained in handling various complications that may occur during labor and delivery, such as pain management, abnormal bleeding, fetal distress, prolapsed cord, and unusual presentations. In case of an emergency, the midwife will assess the situation promptly and act to ensure the safety of the mother and baby. If necessary, they will accompany the mother to the hospital and assist with the transfer.

Midwives  provide comprehensive postpartum care after a home birth, including physical recovery, emotional support, lactation support, newborn care, and family planning. They offer a personalized approach tailored to the unique needs of each mother and baby, with services ranging from a series of visits in the first few weeks to ongoing care for several months. Midwives are trained to offer a full range of care to new mothers, helping them manage physical discomfort, provide emotional support, support breastfeeding, care for newborns, and make informed decisions about family planning.

The outcome of a home birth attended by a midwife can be influenced by various elements, including the health of the mother and baby, the birth conditions, and the skill and knowledge of the midwife. Nevertheless, research has demonstrated that the outcomes of home births overseen by midwives can be comparable or even better than those of hospital births for low-risk pregnancies. One study, published in the Journal of Midwifery and Women’s Health, found that the perinatal mortality rate for planned home births was similar to that of hospital births, and that the rate of interventions such as induced labor or C-section was lower for home births compared to hospital births. 

Insurance coverage for home births with midwives can vary. Check with your insurance provider to find out if your plan covers home births, what requirements must be met, and how much of the cost will be covered. Remember, even if covered, there may still be out-of-pocket expenses. If not covered, you may pay for the services out-of-pocket, which may be lower than hospital births. Understand your insurance coverage and costs before deciding on a home birth.

Some questions to ask your insurance provider:

• Does my insurance plan cover home births with a midwife?
• Are there any specific requirements that must be met for my home birth to be covered?
• How much of the cost will be covered, and how much will I need to pay out-of-pocket?