Choosing a great midwife to attend your home birth is a huge, and sometimes, daunting task. You’re here because you want to choose the best midwife possible. Let’s make that a reality.
A home birth is typically a very personal and intimate experience. You want to make sure you choose a midwife for your home birth that will enhance this experience for you. You want to be sure that you choose a midwife that will keep you and baby safe, aid in the birth you envision, and put you at ease.
Here are the steps you’ll need to take to choose a great midwife for your home birth:
- Get educated about the different types of midwives.
- Have a thorough understanding of the insurance coverage that may (or may not) be offered for various types of midwives and home birth.
- Locate resources to help you find midwives that attend home births in your area
- Arrange midwifery interviews with a few possible candidates after some online research
- Choose the midwife that feels like the best fit for you!
With these five steps, you will surely find the perfect midwife to attend your home birth. But let’s unpack this a bit a more. Knowing more about different types of midwives, how to locate insurance information, and where to turn for resources is going to make your search far more productive.
Five important steps to choose a great midwife for your home birth
1. Learn about the different types of midwives
Before you even start your search, it’s good to have an idea of the different options available to you for your home birth. There are a few different types of midwives, and you may feel strongly about which you’d like to attend your birth. Knowing this before you start your search will help you narrow down choices before setting up interviews.
Some standards are true of midwifery care regardless of the type of midwife. You can expect to receive a high standard of:
- Personalized prenatal care throughout your pregnancy
- Constant support for your physical AND mental health throughout pregnancy
- A hands-on approach to birth with lots of encouragement and minimal (if any) medical intervention
- A highly experienced professional
- Postpartum care and support through the first ~6 weeks after birth
Certified Nurse Midwives (CNM)
A certified nurse midwife (CNM) is a registered nurse with a master’s degree in nursing midwifery from an accredited program. CNMs have extensive training in pregnancy and birth. CNM’s have a medical background and are certified by the American Midwifery Certification Board.
CNMs typically attend births in a hospital setting and are associated with OB/GYN offices. However, CNMs may be trained to deliver outside of the hospital in settings like birth centers and homes as well.
Certified Professional Midwives (CPM)
According to NARM (North American Registry of Midwives), a certified professional midwife (CPM) is a professional independent midwifery practitioner that is highly experienced and skilled at delivering babies outside of hospitals. CPMs typically delivery in homes and birth centers. They carry low caseloads of 3-6 births per month. This results in a highly personalized experience.
CPMs are mainly trained through a rigorous and lengthy apprenticeship process (including 50+ births) and must complete a written examination as well before certification is granted by NARM.
CPMs attend births, but are also trained and certified to provide prenatal care, postpartum care, and newborn exams. Their specialty is attending births outside of the hospital.
Direct Entry Midwives
Direct entry midwives (DEMs) are also independent midwifery practitioners. DEMs learn through midwifery school, or college programs in midwifery. Like CPMs, they also learn through extensive apprenticeship and self-study. DEMs are not certified by the North American Registry of Midwives, and DEM regulation and certification varies state by state.
DEMs provide prenatal care and attend births at birth centers and homes. These practitioners also specialize in birth outside of hospitals.
Lay Midwives
A lay midwife is an individual who is essentially a self-proclaimed midwife. Lay midwives are usually trained in midwifery care, but these individuals have no licenses or certification to practice midwifery care. There is no set training or certification process in place for lay midwives.
Lay midwives are often associated with alternative medicine. They most often attend births in home setting and some birth centers.
What does this mean for you when choosing a midwife for your home birth?
The majority of home births are attended by CPMs and DEMs. These midwives have extensive experience with birth centers and home birth. They specialize in birth outside of hospitals. Both of these wonderful midwife options are highly trained and adhere to regulations and certifications at a national and/or state-wide level.
It’s not impossible to have a CNM attend your home birth, but you should know that it is not the norm. CNMs typically deliver babies and offer prenatal and postpartum care through hospitals and OB/GYN offices.
2. Understand your insurance coverage
Now that you know about the different types of midwives available to you, it’s important to check in with your insurance company. Trust me. You want to do this before meeting the midwife of your dreams and finding out you can’t afford them out of pocket.
Call your insurance company directly
Insurance companies nationwide vary in the coverage they provide when it comes to births attended by midwives, though most do cover it. When Obama passed the Affordable Care Act in 2016, it provided far more options for pregnant women.
The ACA made it so that maternity care has to be covered for all women and that providers cannot be discriminated against. Because CNMs are recognized as licensed providers in all 50 states, that means birth attended by a CNM must be covered by insurance. The laws on CPMs and DEMs vary more state-by-state, but in many states these practitioners are covered as well.
When it comes to home birth, there is unfortunately a bit more variation in coverage. For this reason, the quickest way to get a precise answer is to call your insurance company directly.
Look into your state’s laws surrounding midwifery care, home birth and insurance coverage
A good place to start is by looking into the laws unique to your state. Some states have legislation requiring coverage of births attended by midwives for home births. Others allow insurance coverage for home births, but only under certain circumstances.
Fortunately, there is definitely a nationwide movement to bring the option of home birth to all women, not just the ones who can afford to pay out of pocket.
Check out your state’s laws with MANA’s State by State resource list.
3. Where to find that great midwife
Ah. Once the logistics are out of the way it’s time to get your Google on! By now, you should have an idea of the type of midwife you’d like to work with and what your insurance coverage includes in terms of a provider for your home birth. With these two items complete, you can browse your options from an educated perspective.
Utilize online databases
A great place to start your search is with online databases of midwives that attend home births. The American College of Nurse-Midwives “Find a Midwife” tool is perfect for this. It allows you to search by address, select the type of birth site (home!), and the distance the midwife is located from your home.
Check with local establishments
Next, get recommendations about a great midwife for your home birth by contacting local establishments. The following suggestions are examples of prenatal and postpartum care professionals and facilities that may be able to recommend or put you in contact with midwives that attend home births:
- Breastfeeding support group leaders, such as Le Leche League
- Postpartum support groups for new mothers
- Local doula networks or alliances
- Prenatal yoga or fitness studios in your area
- Childbirth educators
- Birth Centers in your area
- Conventional women’s health centers (OB/GYNs) that include midwifery care
Keep in mind that some birth centers offer home births as an option. In this model, you’d meet the team of midwives at the birth center and choose who you’d like to attend your home birth. In this scenario, you’d likely receive your prenatal care at the birth center location.
Ask friends or online communities for midwife recommendations
What better way to find a great midwife than by a word of mouth recommendation? If you have friends or loved ones that had home births in your area, get all the details about their midwife! If not, try turning to online communities.
There are many “natural/crunchy” mom groups on Facebook specific to states or regions. This is a great place to post your query and find a network of like-minded individuals. Try posting that you are looking for a midwife to attend your home birth, and you will be met with positivity and some great leads.
Look regionally and know your midwife is likely willing to travel a bit
Naturally, the number of options available to you will depend on where you live and your state’s laws and regulations surrounding midwifery care for home birth. As you begin your search, be sure to keep in mind that midwives who deliver in home settings are usually prepared to travel some distance.
Midwives who offer home birth services typically do not have high caseloads. This makes them available to you at a moment’s (or hour +) notice. For this reason, be sure to search your region widely, and don’t forget to consider midwives located across state borders if you are not too far geographically.
Learn as much you can online before arranging interviews
Take the time to dig into your candidates a bit online. Some individually practicing midwives will have websites for you to browse with information, FAQs, and even testimonials from deliveries they’ve performed. This provides excellent insight into their services.
Learning as much as you can before you set up your interviews with possible candidates will help you narrow down options. It will also help you create a list of exactly what you want to ask.
4. Arrange some midwifery interviews
By now, you hopefully have a short list of candidates. How short will likely depend on access to midwives that attend home births in your region. It’s time to set up some interviews! Spending time chatting with your potential midwife and asking questions about their experience and know-how is important.
Get a feel for their philosophy and vibe
You want to get a feel for their personality and style, and see how you and your partner ‘click’ with them. Be sure to understand their birth philosophy and make sure it matches your own.
Talk about logistics
Additionally, this is a time to ask about their experience with home birth, what supplies and equipment they will provide, and what you need to have on hand. You can ask questions surrounding prenatal and postpartum care as well.
Meet in person and have your partner present
Ideally, you want to meet with your potential midwife in person, but in the event of far travel distance, you could use technology such as a video call for the initial meeting. If you have a partner or other important support person who will be attending your birth, it’s a good idea to have them present at the interviews as well.
Questions to ask at a midwifery interview:
- What are your certifications and how long have you been practicing midwifery?
- What is your experience surrounding home birth?
- Do you work with a consulting physician? Are you affiliated with a hospital that will guarantee a home to hospital transfer if necessary?
- Do you work with a back-up midwife should you not be available during my labor?
- Are you available during the month I am due?
- Where will prenatal visits take place?
- What experience have you had with labor, birth, and/or newborn complications? How did you handle the situation?
- What supplies will you bring with you on the day of delivery? Specifically, what interventions and resuscitation devices will you have with you?
- What supplies do you recommend we have in the home to help during the home birth?
- Do you practice with a student-midwife or other assistant?
- Do you have a doula you can recommend or prefer to work with during home births?
- Do you perform water births in the home?
- What newborn care and procedures do you typically administer?
- What can I expect in terms of postpartum care?
- What tests do you recommend or perform during pregnancy (if any?)
- What complications or factors might deter you from allowing me to attempt a home birth?
- What are the most memorable home births you have attended?
- What happens if I am overdue or go into labor well before my due date?
- Do you have client reviews or testimonials?
- Include specific questions about your own labor preferences and birth wishes (ie: pain management strategies, location, timeline, support people, etc.)
Get a comprehensive list of questions to ask your midwife in 102 Must Ask Questions for your Midwife.
5. Make your decision!
As you go through the process of interviewing candidates, be thorough and ask lots of questions. They’ve certainly heard it, and probably experienced, it all. You know yourself best. Is experience and credentials at the top of your priority list? Maybe general ‘vibe’ and energy is most important to you. Or perhaps a hybrid of the two.
Whatever the case may be, this is not a decision to take lightly. You want to select a midwife for your home birth that is going to be an all-star team leader. You want to feel confident in this person and completely at ease during your home birth.
Having a strong sense of your own birth wishes and knowledge of prenatal, birth, and newborn care procedures, and possible complications will help you ask the right questions and feel more confident in your decision. Choosing a great midwife for your home birth is deeply rooted in your own active role in your pregnancy and birth.
Other things to consider and questions you may have before choosing a midwife for your home birth
The five steps outlined above are the essential steps towards finding your perfect midwife. However, as you start exploring options and get educated on midwifery care and home birth in general, some other questions might arise.
As you are making your decision and choosing a midwife for your home birth, you want to go into the process with as much know-how on midwives and home birth as possible.
When should I look for a midwife for a home birth?
You want to start looking for a midwife for your home birth soon after you find out you’re pregnant. Prenatal care typically begins between week 6-10 depending on your provider, so ideally you’d have a midwife chosen in this time frame.
The reason? You want to receive your prenatal care from the midwife who will attend your home birth for the duration of your pregnancy. This will result in a strong bond with your care provider. Your midwife will know the ins and outs of your unique pregnancy, and be able to constantly assess and determine your eligibility for a safe home birth.
Remember that some birth centers offer prenatal care in their facility and have midwives on staff that will travel to your home for birth.
If you are reading this prior to conception but want to have a home birth, it’s never too early to start making a list of options in your area.
What equipment do midwives bring to a home birth?
According to the American Pregnancy Association, most midwives will bring a number of supplies with them on the day of delivery including:
- Oxygen for the baby and mom (if needed)
- Fetal monitoring equipment
- Equipment to monitor the mother’s vitals
- IVs for mom in the event of dehydration or in need of additional nutrients
- Sterile equipment for suturing tears
- Medications to be used in the event of excessive bleeding
- Sterile equipment for cord clamping and other instruments that might be needed at the time of birth
- Hanging scale for weighing the baby
- Homeopathic remedies such as: essential oils, acupuncture needles, herbal preparations
When interviewing midwives to attend your home birth this is an important question to ask. Also find out what the midwife recommends you have on hand during birth.
Do all midwives deliver in out-of-hospital settings?
In short, no. Not every midwife delivers in out-of-hospital settings. The majority of CNMs deliver in hospital settings and are affiliated with OB/GYN offices. However, you can to find a small group of CNMs that deliver in birth centers or homes.
CPMs and DEMs specialize in out of hospital births. Since they are not state of federally licensed providers they are not allowed to deliver in a hospital.
What’s the difference between a CNMW, CPM, and doula?
- CNMW/CNMs (certified nurse midwives) are registered nurses with a master’s degree in midwifery nursing from an accredited program. These practitioners have an extensive medical background. They’ve learned in a medical school setting as well as through experience.
- CPMs (certified professional midwives) are not nurses. These practitioners attend classes and receive the bulk of their training through a lengthy apprenticeship program. This certification is awarded by NARM (North American Registry of Midwives).
- Doulas are professional birth support people. They are typically trained and certified individuals that support women throughout childbirth. Doulas provide physical, emotional, and educational support to birthing mothers and their partners/loved ones. There are also postpartum doulas that provide supporting during the weeks follow birth. Doulas do not take the place of a midwife during a home birth.
Are all midwives also nurses? Do all midwives have a medical background?
Not all midwives are nurses or have a medical background. CNMs are midwives that are registered nurses and have a master’s degree in midwifery nursing from an accredited school. CPMs are certified birthing professionals but do not have an explicit medical background.
What can I expect from midwifery care?
Under the care of midwife, you can expect to receive what’s known as the Midwifery Model of Care. This standard of care was developed through a collaboration of midwifery organizations within North America in 1996 to create consistency in midwifery care.
The hallmarks of the Midwifery Model of Care are:
- Care for the physical, psychological and social well-being of the mother throughout pregnancy, birth and beyond.
- Personalized prenatal care full of education, counseling, and support
- Hands-on assistance during labor and delivery
- Emotional, social and physical support during the postpartum period
- Avoidance of technological interventions
- Recognize and refer women who require medical attention from an OB/GYN
How to find a midwife for a home birth?
Above we discussed the best ways to go about finding a midwife for a home birth. A great place to start is a search using an online database of midwives.
Next, make phone calls to facilities in your area that offer prenatal, birth, or postpartum services. Contact prenatal yoga studios, support groups, birth centers, doula networks, etc. to see if they can recommend or point you in the direction of local midwives that attend home births.
Additionally, get active in local social media groups. Typically, you can find mom or pregnancy groups on Facebook specific to your state or region with interests in natural births, home births, water births, etc. These individuals will be willing to share their experience and knowledge about home birth and midwives in your area. This is a great way to get a word of mouth recommendation.
Find the perfect midwife for your home birth, momma!
You are now equipped with the knowledge you need to choose a great midwife for your home birth.
- Start by getting educated about the different types of midwives.
- Next, understand your specific insurance plan’s coverage of home birth and birth’s attended by different types of midwives. Looking into your state’s laws might also help with this process.
- Third, start putting your feelers out there and doing your research to find eligible midwives in your area.
- Then, set up interviews. Be sure to ask lots of thorough questions and get a really good sense of the midwife to help your decision.
Above all, listen to your heart and honor your gut reaction when it comes to the midwife for your home birth.
This is your deeply personal, profound and individual experience. Trust that you will know the perfect midwife for your home birth when you meet them.
Planning a birth and all of the choices you will need to make can be overwhelming and pregnancy brain is real girl so make sure to pin this article for future reference.
