Should You Call the Midwife?

Home birth rates continue to increase as moms look for alternatives that offer more control and broader options for their birth plans.

By Amy Gordy Photography Courtesy Nicolle Fletcher

Should You Call the Midwife?

The vast majority of women in the U.S. opt for hospital births; however, the rate of home births is on the rise with the highest rates the country has seen in decades. According to the Centers for Disease Control and Prevention, “the percentage of out-of-hospital births increased from 0.87 percent of U.S. births in 2004 to 1.36 percent of U.S. births in 2012, its highest level since 1975.”

Home birth serves as an alternative to women who may want to have more control over their birth plan, be more at ease during the birthing process or be surrounded by loved ones and comforts of their own home when it’s time for the baby to come. A midwife and doula are essential, educated coaches who can guide a mother through home birth. These two team members do not serve the same purpose, so it’s important to understand the differences.

“A doula is not a midwife, a nurse or an OBGYN,” said Nicolle Fletcher, a certified doula since 2010 and founder of Birth by Design, an organization offering doula services in Central Arkansas. “Doulas are there for the mother and that’s their primary thing. We are there to help create the birthing plan, for support during the delivery and during postpartum recovery.”

Doulas offer emotional and physical support to a mother during the delivery and guidance leading up to and after the birth. “Our clients can expect a consultation, four to six prenatal appointments to formulate birth plans, help preparing mothers mentally and emotionally, talking about diet and exercise and just making sure she’s prepared and ready for this journey,” Fletcher said.

Doulas assist both at home births and hospital births, speaking up for the mother’s wishes if she needs assistance. “Many women choose to birth at home for fear of losing their choices in a hospital. At a hospital there is a hierarchy in place you have to adhere to, and we do encourage people to select a hospital and doctor that’s more aligned to your birth philosophy. At the end of the day, birthing [in a hospital] is a business. There are some amazing doctors out there, whom I love personally, but the reality is a patient gets 5-10 minutes of face time with that doctor each visit, and the doctor typically doesn’t come in the room until you are pushing your baby out. There’s not a lot of support in the actual work of labor there.”

As doulas experience both options for birthing, they are a great place to start when trying to decide which path is right for you. First, Fletcher said, you need to decide what is most important to you. Is it being in your own home surrounded by family, being able to eat and drink and walk around when you want, or having access to pain medication and closer approximation to emergency services should you need it?

Hospital births are more appealing to some women due to the fear of “What if something goes wrong?” At a hospital, a mother is closer to emergency services should she need them, but, Fletcher said, a lot of this fear is based in misinformation.

“Midwives in Central Arkansas are licensed by the Health Department and they only accept low-risk births. Midwives do charting and paperwork and are held accountable for patients. They also know the ins and outs of normal labor. You can go through medical school and never see an unmedicated, natural birth. That’s what a midwife is skilled in,” she said.

According to Ida Darragh, a certified midwife for more than 30 years and executive director of the North American Registry of Midwives, emergencies at home births are very rare. “That’s people’s worry, ’What if I need what the hospital has?’ That scenario is very rare. Most women can stay at home and have a beautiful experience.” She summed up just a bit of what a midwife does in the initial phase including: blood work, monitoring how the body is responding to pregnancy, talking about diet changes if iron is low or sugar is high. A midwife visit will last an hour or more and will increase to weekly once a mother gets close to her due date. A midwife will visit the home to become familiar with where the birth will take place, and make sure the mother is mentally and physically prepared for birth.

“When the birth day arrives the midwife is there to help the mother get in a good position, offer ways to get baby to turn if needed, and offer encouraging support. As birth gets close, we read signs like the baby’s heartbeat and mother’s vitals,” Darragh said.

“Afterward, we’ll continue to monitor for abnormal bleeding and help the mom get into a clean bed, get something to eat, and get the baby comfortable and nursing. A mother needs a lot of rest and to be nourished, and a midwife will return the next day, and more often if needed, to make sure the mother has what she needs.”

Whether a mother chooses to have a hospital birth or a home birth, Fletcher emphasizes that education is key to having the birth experience that’s right for her.

“I try to educate clients to help them understand the physiology first. There’s also a beauty and ease that can come when you have knowledge, and are therefore less fearful. Birth is the only thing in life that people enter into without having any education on it or seeking education. People do it, but it can be done a lot better and easier if you understand what it is,” she said.

Nicolle Fletcher (left) attending a home birth.

Nicolle Fletcher (left) attending a home birth.


Provided by Nicolle Fletcher

1. How do you want to deliver your baby? People look at me and cock their heads when I ask this one. What I mean is, are you interested in vaginal birth or being medicated or unmedicated? It’s getting them to think about how they want to birth the baby.

2. How do you feel when you are with your doctor? At prenatal visits do you feel at ease? Rushed? Does the doctor listen and pay attention to your questions? Is he or she dismissive? This shapes whether you want to stay with that practice or look for another.

3. Do a hospital tour. If you’ve decided on a hospital birth, I encourage parents to do a hospital tour to see what it’s like. Visit nurses. See what’s normal at that hospital.

4. What’s your doctor’s C-section rate? Ask your doctor for his or her C-section rate and the C-section rate at the hospital. Also, ask your doctor what their medicated vs. unmedicated patient ratio is.