In last week’s post, I shared the birth story of the most recent addition to our family, baby number four and our first boy – little James. And I shared that we had a homebirth! I always get lots of questions about homebirths, so in this post, I’m going to share our why behind having a homebirth, as well as answer some frequently asked questions.

We had our first baby in the hospital, we had our second baby at a birth center, and we had our third and fourth babies at home. So in a sense, we’ve “experienced it all,” although I won’t pretend to understand every birth experience – we had midwives deliver all four babies and all four were unmedicated and vaginal deliveries. So although different locations, they were all still pretty similar!

But we’ve absolutely loved our homebirth experience, so I’m excited to share more about it!

I’ll probably say this a few times, as I want to make sure this is super clear…this post is not a, “Why you and everyone else should have a homebirth,” is why WE chose homebirth and what WE love about it.

Maybe it’ll make you consider a homebirth, or if you’ve been considering it already maybe this will help you decide to go for it, but my goal isn’t to convince you of anything. My goal is to share OUR why!

So for the Engler family, why homebirth…

Our hospital birth honestly wasn’t bad. My birth pretty much went according to plan, our favorite midwife delivered us, and we were home two days later! Getting blood transfusions wasn’t part of our plan, but it was all okay!

As we were prepping for that first birth, I told my husband I’d be open to a birth center or homebirth at some point, and he was open to it, as well, but we were both confident with our choice in a hospital for baby number one. And when we were pregnant with baby number two, we actually went back to that same midwife practice that delivered in the hospital! To me, it was the best of both worlds, and already familiar.

But at the first appointment, the midwife said that while she and her partner were still doing prenatal visits, they were no longer delivering – it was just the OBs. And I instantly burst into tears, which I think surprised us both. I didn’t want to be delivered by an OB, I wanted to be delivered by a midwife!

There were just one or two appointments with my first where I had to see an OB because the midwives were at births, and those appointments just felt different. And I thought, if those prenatal appointments felt that different, how different must birth feel!

So in that teary conversation, the midwife mentioned I’d be a good candidate for a birth center birth or homebirth, so I went home, chatted with Jason, and immediately started doing some research.

In hindsight, our midwife experience at the hospital was still different than at the birth center or at home, because there were still hospital rules and norms, like dropping me off and parking in a certain log or garage, it taking 5-10 minutes to get all checked in, getting an IV placed right away, or being hooked up to a monitor. But I’ll get there more in a bit…

As I touched on a bit in my birth story, I have a tendency to bleed a lot after giving birth. With our first, I hemorraghed so significantly I kind of passed out and needed blood transfusions the next day. But in chatting with another midwife after the fact, she told me I likely hemmoraghed due to poor coaching as I pushed, as well as the size and speed of my baby coming out.

I spoke with another midwife that week who used to go to our church but had since moved to Florida, and she agreed I’d be a good candidate for a birth center or homebirth and that the hemorraghing wouldn’t make me a higher risk as it can often be managed safely at home!

I then remember being on the playground after school and chatting with a student parent, and she told me about her homebirth – she had significant bleeding, as well, and she said her midwife hung the IV bag from her ceiling fan. She also told me about births she had doula’d for at a local birth center, and I was quickly sold! We were living with friends at the time, so while a homebirth was appealing, birthing at a friend’s home didn’t sound ideal. So birth center it was!

And for baby number three, a homebirth was a no brainer. The birth center birth went well, the drive there being the worst part, so take out that drive and it’s a homebirth! Plus that midwife who had gone to our church but then moved was back and we were so excited for her to be our midwife for baby number three.

As I sidenote, I want to make a plug that between a birth center and homebirth, I definitely recommend a home birth! Rather than drive to another “house” and then having to drive back to your house a few hours later, having the midwives come right to you and then tuck you into your own bed is a dream!

Homebirth Supplies and Clean Up

I used to think getting all of the supplies for a homebirth must be a nightmare, but it’s honestly so easy. At least for the two homebirths we had, your midwife sends you a link for a birth kit, you order it, and keep it at your house for her to use during delivery! And then you get out some towels and such, but it’s really simple. And it doesn’t take up much space.

And no, having a homebirth doesn’t make this huge mess you have to clean up – very minimal mess was made with our two homebirths, and the midwife cleans up and throws the laundry on before she leaves! So again, a dream!

“You’re not paying for a homebirth, you’re paying for midwifery care.”

Now I want to share something that my most recent midwife said that really stuck out to me. She said, “You’re not paying for a homebirth, you’re paying for midwifery care.” I’ll be honest, the first thought that went through my head was, “It better result in a homebirth, because insurance would cover a hospital birth!” And most insurances don’t cover homebirth. But the more I thought about it, especially after having our fourth, the more it made sense to me.

So I want to share more about what paying for midwifery care meant for our family:

• It meant that pregnancy and birth were a family affair. Our midwives knew our kids by name, kids are more than welcome to visits, they’re included as much as they want, and there’s a stash of toys there for them to play with!
• Midwifery care meant having a say in what happens throughout our care – do I want that initial dating ultrasound? Do I want the GBS swab?
• It meant getting to keep my baby on my chest the whole time after he was delivered – he wasn’t whisked away to weigh him or check his vitals. Everything was done either on my chest, or right next to me on my bed.
• It meant the midwife coming to me for the first postpartum checks instead of me going to her.
• It meant dealing with my postpartum bleeding right from my home because she could. And basing all of what they’re doing not only on what they see, but on how I feel – not basing things on how much blood I lost, but on if I felt lightheaded or dizzy or not.
• With baby number four I actually had a second degree tear, and we didn’t notice right away. So when my midwife came day two to check on me, she decided it was best to stitch it and did right then and there – at 10 pm. And then after that, she had a concern with James’ glucose levels, so she checked all of his vitals and then waited for me to nurse him, wait another 30 minutes, then test his levels again. She was at our house until 2 am on a postpartum visit, because that’s midwifery care!
• Midwifery care is when I passed a pretty sizeable blood clot a few days after delivery (with both our third and fourth, actually.) I texted a picture to my midwife and called her in the middle of the night. She said I did the right thing by calling, explained that it can be normal due to these reasons, she checked to make sure I felt okay (which I did), and said what red flags to watch out for, otherwise to rest and I should be okay. And I was okay, it was just a one time thing! I could have easily been sent to the ER with an OB practice and I would have been talking to some overnight person on call who didn’t know me at all.
• With our third baby, my milk supply took longer to come in – that ended up being connected to oral ties, which I share more about here. But I told my midwife I was concerned about diaper counts, and she talked through a plan with me! She knew my goal was exclusive breastfeeding, and of course had our baby’s health and safety top priority. But rather than telling me to give her formula right away, we made a plan and she kept checking in, and the next day my milk was in and all was well!
• And finally, between baby number three and four we sadly had a miscarriage, and I share all about that journey here. But talk about outstanding midwifery care! She was with me every step of the way, including through a terrible ultrasound and ER visit. It was a really brutal physical experience and I can’t imagine the extra trauma that would have been there without her support and her advocating and countless phone calls, texts, and pictures exchanged.

All of that is the midwifery care we paid for and so much more! It’s so personal and above and beyond what I’ve ever gotten anywhere else.

I’m not saying an OB practice absolutely would not have supported me in any of those ways, but I know it would have been different. They certainly wouldn’t have stitched me at home, they wouldn’t have been up for texts and calls at all hours through my miscarriage, they likely wouldn’t have even handled the milk coming in challenge, that would have been a pediatrician referral. And those OB office rooms definitely aren’t generally as kiddo/sibling friendly as a midwife’s office!

Again, not saying OBs are bad by any stretch of the imagination, and I’m not saying YOU should have a homebirth, but this is why homebirth and midwifery care won for us. But I am highlighting what it means to pay for midwifery care and what really stands out about that for me.

Differences Between Hospital Births and Homebirths

A huge difference between hospital births and homebirths is standard practices versus evidence-based practices. Again, this is not a “why homebirths are better” list, but I will say I think it’s important to know these things even if you’re delivering in a hospital, as it can give you more voice and more choice.

So when delivering with OBs and at the hospital, they usually follow what I’ll call “standard practice,” rather than “evidence-based care” – there’s a lot they do just because it’s the norm, not necessarily because it’s evidence-based. I won’t go into too much nitty gritty, but here are a few examples:

• It’s routine for babies to get erythromycin ointment in their eyes shortly after they’re born. This is an antibiotic given to prevent infection in baby’s eyes if mom has an STD. But if mom doesn’t have an STD, it’s totally unnecessary! But that’s not generally explained (at least it wasn’t to me with our oldest!). Whereas at the birth center and homebirth, they ask if we want it, they explained what it’s for, and since I don’t have STDs, we said no!
• Routine 3^rd trimester ultrasounds – lot of practices recommend these ultrasounds to check on baby’s size and such. And for parents who want that, maybe want another cute ultrasound to hang on the fridge, go for it. I’m not going to get crazy and talk about extra radiation or anything your baby is exposed to, because I think people get a little crazy about that. But I will say that checking on baby’s size just because really doesn’t need to be routine! I needed a third trimester ultrasound with baby number four because my midwife felt extra fluid and she wanted to make sure everything was still okay, but I didn’t get one that late with our other three. And an ultrasound “just because” really isn’t necessary – plus it can scare some people out about baby’s potential size and some moms or doctors might change delivery plans because of it. And it’s often just not necessary.
• Cervical checks during pregnancy – like I said last week, we did get a cervical check with our fourth. Our midwife did check me after our due date because we were thinking about natural induction since my husband would be out of town soon and she had to check me to be able to do a membrane sweep. But whether you’re not dilated at all or you’re 2 cm dilated honestly doesn’t really mean anything! You can go from 0 to 10 pretty quickly, as I shared last week happened to me, and you can also sit at 2 for a while. But it’s just become routine for so many. And with our second, third, and fourth babies, I actually didn’t have any cervical checks at any point during labor! So you have choice here.
• Delivering your baby on your back – according to PTs, and of course doulas and midwives and such, birthing on your back doesn’t set your body up very well to really open your hips and help baby move down and out. Being on your side or on all fours is much more efficient and works with the way your baby needs to descend. Yet being on your back seems to be the “easiest” for a lot of doctors, so it’s the norm at the hospital.
• Most hospitals also restrict food and water intake during labor, which still really blows my mind. As a mom, you’re about endure one of the most physical events of your life, and you’re expected to do it with little fuel? The reasoning is if you were to need an emergency c-section and go under anesthesia, there’d be a risking of vomiting and choking. And I’m not belittling the seriousness of something like that, but I am saying mama needs to eat! I talked to a nurse one time who worked at a hospital that did allow fruit and clear liquids, so some are a bit more flexible. Other nurses, or even doulas, sometimes encourage you to eat when they’re not in the room. Whereas at the birth center and home birth, they’re encouraging you to stay fueled up because there’s no telling how long labor will be!

On a similar note, it also seems like there’s a cascade of interventions that can happen quickly during hospital births. Inductions that are scheduled earlier than usual due to scheduling restrictions. So mom’s body isn’t ready, the induction takes a long time, now mom’s exhausted from an already long labor, gets the epidural she was hoping to avoid, and then they pull out the vacuum to help get baby out. (Yes, I’ve seen that happen!)

So again, please don’t hear me saying that any of these things are bad, or you’re wrong to want them, or your OB isn’t great at their job for doing these things. There are certainly situations when an extra ultrasound is important, or your baby does need the eye cream, you need to be induced, or you have to deliver on your back.

But I am saying there are practices that shouldn’t be standard for everyone if they’re not evidence-based, and we are our own greatest advocates! And I’m not saying some inductions are necessary. But you wonder what would happen if the induction wasn’t scheduled so early, if there was a bit more time, less pressure, more listening, waiting, and leaning in.

I think it’s important to know these things if you’re delivering at the hospital so you can ask about them, talk about them, know what the expectations are – and ask about what options you have!

The whole way along this pregnancy, I always said I held the homebirth with open hands – that we “planned on having a homebirth.” If we had to transfer to a hospital for whatever reason, I would both be thankful for the hospital and sad we couldn’t stay home. Homebirth isn’t a given just because that’s your plan, so even though we had already had one and it was important for me to again, we tried our best to remain open-handed with what happened so I could still enjoy my birth!

CNMs versus CPMs

One final logistics piece to share about midwives and homebirth was a shock to me after moving from Virginia to Ohio. Different states have different requirements or allowances for midwives.

So in Virginia, my midwife was a certified nurse midwife (CNM), and could do so much of the medical stuff – bloodwork, order labs, order ultrasounds, IVs, postpartum meds, etc. In Ohio, however, CNMs only work in the hospital setting. So the homebirth midwives are certified professional midwives (CPMs), who are still incredibly talented, but they’re more limited in what they can do medication-wise. Which is a bummer, because it’s a lot more limiting to giving mama’s the care they need to be able to stay home after having a baby. Like for me, someone who very likely will bleed more – but it’s just the way it is.

So I think it’s helpful to know that each state is a bit different with their laws regarding homebirth midwives and it’s good to know what interventions your midwife can or cannot do from home.

Conclusion

In all of this, from this birth and baby lover, when I think about mama’s having babies (which I think is just the coolest and most beautiful process!), I want them to enjoy their labor! To see it as beautiful and special. And if that’s at home, yay! If that’s at the hospital, great!

I know people who love the epidural and get it placed right when they get to the hospital. I know others who choose to be induced at 38-39 weeks because they’re just over being pregnant and it goes well for them! I know people who love getting to stay at the hospital and have the option of using the nursery for baby so they can get some sleep. That’s what helps them enjoy their labor and see it as a positive event!

So loving birth doesn’t have to mean homebirth or even natural birth. So again, don’t hear me say you have to have a homebirth, or you are less than for having a hospital birth, or that the interventions you had weren’t right. I hope you did hear why WE chose homebirth, and hopefully it answered some questions you may have had, as well.

The whole plan of this post is to share more about why WE chose homebirth for our family. And our plan was to have a baby at home naturally and with little intervention! And thankfully that’s what we were able to do. And the plan is also to share more about homebirth and maybe answer some questions you had about it, in general.

Also remember there has to be a lot of grace! We had to stay open-handed in our homebirth plans. Additionally, homebirth isn’t right for everyone, or both partners might not be comfortable with it, or it might not be a great option in your state, and just remember there is grace.

With Grace,

Lauren