Choosing a care provider and the environment within which you will give birth is a huge decision with a lasting impact. It is important to be thoughtful and informed while honoring your desires. Are you considering an out-of-hospital birth with a Licensed Midwife? Here are some questions to ask yourself, as well as some answers about home and hospital birth.

What type of environment do I feel safest within?

Many women and families that choose home birth feel safest within the comforts of their own home. For a variety of personal reasons, the hospital may present more anxiety than the home.

How well do I want to know the providers who will care for my baby and I during my labor and birth?

When choosing an out-of-hospital birth, the midwives that care for you during your pregnancy are the midwives that attend your birth and care for you and your baby during the postpartum. It is a comfort for many women and families to know who will attend their birth. When choosing a hospital birth, you may meet with many different care providers during your pregnancy, and the provider that attends your birth is whoever is on-call that day/night. This provider may change during shift turnover. Additionally, if you give birth at a teaching hospital, there may be residents, nurses, and medical students that care for you.

What is my length of appointment preference?

Out-of-hospital providers generally offer an hour for every prenatal and postpartum appointment. The length of an appointment in the hospital setting is variable and generally shorter.

How long has my provider been in practice? What is his/her educational background?

Out-of-hospital midwives come into their profession from a variety of educational backgrounds. It is important to know how your midwife became a midwife, and for how long she/he has been in practice. Out-of-hospital midwives include Certified Professional Midwives, Certified Midwives, Certified Nurse Midwives, and Naturopathic Doctors. Physicians have a more predictable and standardized educational background.

Is informed choice important to me? Do I want to accept every screening test or procedure routinely offered for my baby and I?

There are many screening tests and procedures routinely offered during pregnancy and the immediate postpartum. Some include ultrasounds, genetic screening, gestational diabetes screening, Rhogam, Group Beta Strep screening and prophylactic treatment, vaccines, newborn eye prophylaxis, vitamin K, the newborn screen, etc. Some providers offer these screenings and producers without a great deal of education and informed consent. Although informed consent should be as free of bias as possible, you may be able to sense a provider’s position on various screening tests and procedures by asking some basic questions.

What is the out-of-hospital provider’s transport rate? What is the epidural, VBAC, and cesarean rate at a particular hospital?

Out-of-hospital providers have very low transport (less than 10% during labor in VT) and cesarean rates (less than 4% in VT). Every hospital has these statistics available to the public.

Does my provider accept insurance? What kinds of payment options does a provider offer?

Out-of-hospital providers may or may not accept insurance. This is a very important factor to discuss when choosing a provider. To increase access to home birth, many midwives offer alternative payment plans and options.

What happens if I have to transport from the care of an out-of-hospital provider to one within the hospital?

A transfer of care during pregnancy or during labor is uncommon and most often non-emergent. Transports during labor are rarely by ambulance, and it is a decision is made with the family. Every out-of-hospital provider has her/his own transfer/transport plan. Depending on the reason for transfer/transport, you may be able to receive care from a hospital-based midwife.

To what degree do I want the freedom of movement during my labor?

Within the hospital setting, you may be limited to your room/birthing unit. When at home, you have the freedom to be wherever you want to be within or outside your home.

Do I want relatively immediate access to pharmacological pain relief methods?

An anesthesiologist is a call away when giving birth in the hospital. At home, women have access to only non-pharmacological methods of pain relief. This includes hydrotherapy (shower or birth tub), TENs (Transcutaneous Electrical Nerve Stimulation), aromatherapy, massage, acupuncture, acupressure, etc.

How many people do I want at my birth?

In the out-of-hospital setting, you can choose who attends your birth. Within the hospital, you may be limited to how many family members and friends provide support.

If I have other children, can they be present at my birth?

Children are often not allowed to attend births in the hospital setting. At home, this is an option.

Do I want the freedom to eat and drink during my labor?

At home, there are not limitations on eating and drinking during labor.

How do I feel about electronic fetal heart rate monitoring versus intermittent fetal heart rate monitoring with a Doppler?

Many hospitals now offer wireless electronic fetal monitoring. This allows the monitoring to be continuous while you move about. At home, midwives assess the fetal heart rate intermittently with a Doppler or fetascope. A Doppler does not remain fastened to a laboring woman’s body.

I hope these questions and answers are thought provoking and helpful. Please share further thoughts, comments, and/or questions in the comment section below!