Frequently Asked Questions
Is home birth safe?
Several studies have researched the issue of the safety of home birth in various countries around the world. The best research continues to show that home birth for women with low-risk healthy pregnancies, attended by a qualified birth attendant, is no more risky than birth in the hospital. Not only that, but in the U.S., women choosing home birth with a midwife have far fewer interventions during their labor, birth and immediate postpartum period, contributing to easier healing, breastfeeding and bonding with their new babies.
Homebirth with midwives is common for low-risk women in many other industrialized countries (Canada, UK, Australia, New Zealand, most Scandinavian countries, the Netherlands, Japan, the list goes on), and the safety of homebirth with midwives is well-established and accepted. In fact, in the UK there is a push to get low-risk women out of the hospital and have their babies at home or in birth centers with midwives because the obstetricians are recognized as specialists in high-risk pregnancies. US obstetricians are trained as high-risk providers too, but our culture values high-risk specialists caring for low-risk women. Midwifery education is focused extensively on normal pregnancy and birth, and midwives are often considered to be the "experts" in normal birth. The best research concludes that midwife led care results in better birth outcomes.
Homebirth studies which include women who have high risk pregnancies show more negative outcomes for the baby than studies that only include low risk, healthy women during pregnancy and birth. For that reason, Vivante midwives only attend birth at home if the woman has a normal, healthy pregnancy and birth.
What are the advantages of home birth over hospital birth?
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 an unmedicated birth. Home birth has a lower rate of interventions such as pitocin, epidural, and unnecessary IV
- More control and more choice in who is present for the labor and birth, what position to labor in, whether to eat and drink, etc.
- Continuity of care throughout the pregnancy, labor, birth and postpartum periods
- Security and comfort of being in your own home. Plus the added benefit of seeding your baby's gut with the microbiota/flora found in your home versus hospital bacteria
- Feeling heard, respected, and empowered
- Supporting informed choice through education and resources
- Less anxiety and stress
- Immediate close contact with your baby
- Lower risk of having an unnecessary cesarean
- Increased family unity
- Lower cost
- Higher satisfaction level
What equipment do the midwives bring to my home for the birth?
The contents of each midwife's birth bag may be very different, but most licensed midwives carry similar basic equipment to all births:
- 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 doppler 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 maternal rehydration
- maternal antibiotics, if desired, for presence of Group B streptococcus
- Vitamin K and eye ointment for the newborn
Your midwife may ask you to purchase some other supplies for the birth, such as disposable underpads, gloves, a newborn hat and receiving blankets.
What if something happens during labor?
The midwife’s job during labor is to help create and support space for labor and birth to occur safely. Part of that process is monitoring for signals or signs of a potential or actual concern that could lead to trouble. The majority of problems that occur during labor and birth present warning signs. Midwives are extensively trained in recognizing the warning signs that tell us that labor has gone outside of what is normal.
Not every problem requires a trip to the hospital; sometimes, just a change in the laboring person's position or rehydration solves the problem. Issues requiring a hospital transfer most often happen during labor, but can sometimes come up in the first few hours after the birth as well. The most common reasons for going to the hospital during labor include:
- exhaustion and/or request for pain relief (this is more common in people laboring for the first-time due to very long labors)
- the cervix isn't dilating appropriately (often due to the baby's head being turned in an uneven position)
- the baby's heartbeat is indicating that the baby is stressed for some reason
Infrequently, there are circumstances that are more urgent and require a call to 911. Examples would be sudden, severe changes in the baby’s heart rate indicating true distress (most likely to occur when the mother is pushing) or sudden onset of unusual bleeding in labor suggesting a problem with the placenta or an unusual amount of bleeding following the birth of the placenta.
There are also extremely rare events that can occur during labor or birth that present no warning signs. Examples would be a tear in the placenta or some type of clot (embolism) in the mother’s lungs. These very rare events are life-threatening no matter where the mother is when they occur (home or hospital). Hospitals (some, not all) would have more equipment and a larger number of trained health care personnel immediately available to respond to this kind of emergency than would be possible at home.
Because these very rare events are immediately life-threatening, there is no guarantee that the mother or baby would be okay even if they were in a hospital. Often, because these events are sudden and quick, there is nothing that can be successfully done to protect mother or baby despite everyone’s best efforts. Emergency personnel and specialized equipment are more available in a hospital setting. It is important for families considering home birth to be willing to accept these risks.
What are some reasons why I wouldn't be able to have a home birth?
Most people with low-risk, healthy pregnancies can have a home birth. Risk criteria vary from state to state, but in most places, a person is no longer considered to be "low-risk" if any of the following occurrences happen in the prenatal period, during labor, or immediately postpartum:
- abnormal bleeding
- Rh-negative status and has become sensitized to Rh-positive antigens
- high blood pressure
- pre-existing diabetes (this is different from "gestational diabetes")
- heart, kidney or lung disease
- heavy alcohol or drug use (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)
- development of pre-eclampsia
- labor begins before 37 weeks of pregnancy
- the pregnancy continues longer than 42 or 43 weeks
- severe anemia
- postpartum hemorrhage
- a severe tear to the vaginal, rectal, or perineal tissue that requires additional instruments, skill, or anesthesia to repair properly
- the baby's umbilical cord prolapses when the water breaks
- the baby's heartbeat indicates that it is stressed
- the newborn has problems such as infection, respiratory distress, or severe hypoglycemia
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.
This is my first baby. Is home birth right for me?
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 parents and have beautiful home births. If you are interested in learning more, please contact us.
Is home birth messy?
Not really. Most midwives use the same blue plastic-backed pads that are used in the hospital, and we spread plenty of these around underneath you to catch any fluids. We often recommend that you protect your pillows by covering them with plastic and put an old pillowcase over the top. A really handy thing to make is a special throw that can be picked up, moved around and laid down on the sofa, floor, bed, or wherever you want to be laboring or pushing. Directions for how to make this throw blanket can be found on our client info/resources page. Our midwives do a great job of cleaning up after the birth and will often start a load of laundry for you before we leave.
Can we keep the placenta?
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. Some of our midwives (Amy Jo and Sharon) have been trained in placental encapsulation and can perform this service for our clients for an additional fee. 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, your midwife can dispose of it for you.
Is waterbirth safe?
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 people typically choose whether to labor and birth their babies in the water, just like they choose home birth, and it is often difficult to know if people who choose waterbirth are different from those 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 doppler. 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, a nurse and childbirth educator who has researched and supported home birth for decades.
What is the difference between nurse-midwives and direct-entry midwives?
A Certified Nurse-Midwife (CNM) is a person who has been educated both in the discipline of nursing and in the discipline of midwifery. A CNM's education occurs in a university program accredited through the American College of Nurse-Midwives and the birth experience is primarily in a hospital setting. They must pass a national exam in order to become certified and then are legal and eligible to become licensed in all 50 states. Most CNMs work in hospitals or birth centers.
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not also require her to become educated as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
- A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.
- A Licensed Direct-Entry Midwife (LDM) is a midwife who is licensed to practice in Oregon. Currently, licensure for direct-entry midwives is available in 27 states, including Oregon and Washington.
- The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.
Where are you located, and is there parking?
We are located at 2928 SE Hawthorne in beautiful SE Portland. Click here for a map and directions. Parking is readily available on Hawthorne right in front of the office or on the side streets. If you're taking the bus, the #14 stops on our corner.
Do you charge for a midwifery consultation?
No, we do not charge for a consultation visit to get to know the midwives and ask questions to help decide whether a homebirth with Vivante Midwifery is right for you.
Are you covered by my insurance?
Certified Nurse-Midwives are covered providers by most insurance companies. Vivante Midwifery is in-network with some providers; see Payment Information for details. Some insurance plans do not cover a birth at home, but will cover prenatal and postpartum care in the office. We will work with your insurance company to estimate how much is covered and what, if any, out-of-pocket expenses you might have to pay.
Can you attend homebirths in Washington?
Yes. There are very few Portland midwives who are licensed to attend births in Washington. Several of the midwives in our practice are licensed in both Washington and Oregon. We are happy to attend births within a reasonable radius of the Portland/Vancouver metro area.
What forms of payment do you accept?
We are happy to work with most insurance providers for your maternity care. We obtain an estimate of how much (if any) your insurance is likely to pay for a homebirth, and the remainder can be paid by you in one lump sum or in monthly payments by cash, check, or credit card. For those clients who are paying the entire amount themselves, discounts may apply for early payment. See Payment Information for details.
Are there any former clients I can contact about your services?
Absolutely! We try to match up our references to each particular situation (first-time mom, interest in waterbirth, etc.), so please contact us if you would like a list of references that are similar to you.