Out-of-Hospital Births & Home Births in the NOVA & DC Metro Area

Recently, there have been so many changes happening on the national and global level with the spread of the COVID-19 virus.  Pregnant families are feeling the stress on an immediate level, as they grapple with feelings of safety for their unborn child and as they look to navigate the birth scene for their newborn and their personal mental health.  Many doulas across the NOVA & DC metro area and nationally have had clients express a desire to explore what a home birth would look like for them, and home birth midwives have reported receiving an unprecedented number of pregnant people reaching out to them for last minute transfers.

Just like hospital births are not for everyone, out-of-hospital births, whether in a birth center or at home, are not for everyone. This blog will shed some light on a few topics that many individuals might be grappling with as they consider what their options are.  As always, do your research, reach out to a birth professional to ask questions and know that your local doula is always ready to help you think out loud and find the best local resources.

Safety

One of the first concerns that comes up for many who hear about home births for the first time surrounds the idea of the how safe an out of hospital birth is.  Home birth and birth center midwives are always glad to address this issue in detail in any interview you may have with them.  In the majority of cases, 85-90% of births are considered low-risk, and are eligible for care by a homebirth midwifery practice.  Midwives are trained in all things birth-related- including how to deal with emerging issues, how to decide if it is safe for a client to stay in their care versus transfer to a hospital birth and how to deal with emergency situations in the birth space.

Midwives are required to be up-to-date in neonatal resuscitation techniques, postpartum hemorrhage situations and other emergencies that might arise.  They are trained in dealing with all birth variations, including shoulder dystocia, babies that need help breathing at birth and mothers that are showing signs of distress.  Most homebirth midwives have a list of supplies that they bring with them for emergency and non-emergency situations, including oxygen tanks, pitocin shots and IV lines for dehydration and antibiotic administering (for GBS if desired by the client).

Their rates of maternal and infant mortality are lower than those in hospital births and most midwifery practices are happy to share their annual statistics with clients (see below for some local NOVA midwives’ home birth statistics).  Ask questions, do your research and trust your intuition.

Investment

Home birth midwives in the DC Metro area charge on average $4,500- $5,500 for an entire pregnancy, including in-depth prenatal visits, active birth support and numerous postpartum care visits from day 1 after the birth up until 6 weeks postpartum (on average 4 visits).  In some cases, insurance will cover your birth center or home birth in its entirety.  In other cases, it might cover part of it as an out-of-network provider.

It is definitely worth a shot to call your insurance provider and find out what your deductible is for different situations, including a hospital birth and a home birth.  Many midwives also work with a billing company that will help you figure out how much your insurance may be willing to pay towards your home birth costs.

There have been some recent reports that insurances are more willing to give better coverage for out-of-hospital births with the current Covid-19 epidemic.  When you are making your decision, don’t let finances be an impediment from the get-go; do your research and see if you can work out some sort of a payment plan with your midwife of choice.  But do respect their time and expertise and don’t short-change them.

Some local out-of-hospital practices that accept insurance include:

• Premier Birth Center in Chantilly, VA.
• BirthCare in Old Town Alexandria, VA.
• Fairfax Home Birth with Story Jones.
• Little Star Birth Services with Becky Banks accepts Medicaid (one of the few out-of-hospital providers who does so.)

Personalized Care

One of the absolute biggest benefits of an out-of-hospital birth is the level of personalized care you will receive from a small-scale midwifery practice.

Some home birth midwives work as a solo practice (meaning one midwife and a birth assistant during the birth, who has back-up midwives she can call on in case of an unlikely situation). These solo midwives will either come to your home for all your prenatals and postpartum visits (see Shifrah’s Sisters) or have you come to their office location for prenatals (see Fairfax Home Birth).  Instead of being the traditional 15 minute visit you might have in a regular hospital OB/midwife practice, these midwives will spend up to an hour with you, asking about how you are feeling, answering any questions you may have and getting to know you on a personal level.

That personalized level of prenatal care is one that you will not find anywhere else.  I often find that pregnant woman crave that kind of care in their pregnancy, but they do not realize that it is almost impossible in most high-traffic, hospital birth OB/midwife practices.  In the smaller practices, you see the same midwife each time; in slightly bigger practices, you might be rotating between 2-4 midwives.  I tend to find that birth center midwifery practices (like BirthCare) have a larger number of midwives that work there- and hence you might be rotating between a slightly larger number of midwives.  Nonetheless, personalized care is one of the definite hallmarks of a home birth.

Comfort Measures

For some people, the biggest difference between a hospital birth and an out-of-hospital birth is their access to certain comfort measures; whether that is the ability to labor in a large birth tub or get an epidural.  As a starting point, it helps to learn more about birth physiology and different comfort measures and then make a decision on which type of birth experience you would like to have (medicated vs. unmedicated).  I recommend this really easy to read, short workbook that can help give you a comprehensive look at childbirth- Plumtree Baby- Preparing for Birth.

At that point, if you decide you would really like to go the medicated (epidural) route, then that is one thing that an out-of-hospital birth does not offer- an epidural.  Conversely, in an out-of-hospital birth, you have complete access to free movement in the complete sense of the word, you have access to any deep tub of your choice (including renting a dedicated birth tub from a local midwife) and you have access to freedom from constant baby monitoring and adjusting of belts, saline locks, etc.  Your baby’s heart rate is measured with a doppler (no units attached to your body, one minute of a quick listen) instead of a continuous monitor or a Monica monitor.

Space

I have heard some concerns from families about the space that they will birth in- worries about sound reaching neighbors, privacy if living with extended family members and worries about how their bedroom/living room will look like after a (messy?) birth.

These are all valid concerns to work through and to ask about.  My main advice- before you discount your ability to have a home birth based on these issues, talk it through with your midwife or doula.  Maybe the situation isn’t as big as you are imagining it to be.  Maybe the benefits will outweigh any negatives that come with this.

As a doula, I have personally attended a home birth in a rented, one bedroom, one bathroom apartment for a first time mother- and we did not deal with any noise issues from neighbors (despite the birth being a middle of the night affair, as it tends to be).  The sofa where the birth occurred was brought back to it’s pre-birth state, and no signs of a mess were left by the time the midwife and her assistant left the space.

This was one of my husband’s biggest concerns when we were deciding on a home birth vs a birth center birth with our last child, and without any exaggeration, my midwives left our space in as tip-top shape as it was before they arrived.  After the birth (we decided on a home birth), they loaded our laundry, bleached any spots that needed it and left us in complete comfort in our beds for a long, uninterrupted post-birth sleep (until the little one woke us up).  You know your space and your restrictions better than anyone else; sometimes the benefits of the privacy of your own bathroom and your own bedroom lead to an optimization of your birth hormones that you might not be able to reach in a hospital birth.

Home Birth vs Birth Center Birth?

When thinking about space, you might debate between having a home birth and a birth center birth. Some things to take into account-

• Travel– with a birth center birth, you travel to the birth center in labor (just like with a hospital birth) AND you and your baby travel back home about 4 hours after the birth- when all newborn and new mother checks have been completed.
• Privacy and/or Safety– The birth center may provide you with the privacy or space that you need if you are living in a shared/extended family living plan.
• Familiarity- In a home birth, you may feel completely at ease in the privacy of your bedroom, bathroom, space.  You know where everything is, you can find the nooks and positions that feel most comfortable to you.
• Amenities– one place may have more of the amenities that you need than the other. Perhaps the birth center provides a large tub for laboring in that your home doesn’t, or access to nitrous oxide for comfort measures (read up more on the positives and negatives of NO2).

Consider Attending a Virtual Meet the Midwife Open House-

Many local out-of-hospital midwives (home birth and birth center) are holding virtual Open Houses and Meet & Greets to answer questions about their practice and what to expect in an out-of-hospital birth. Attending one of these is a great way to dip your feet in the pond and get some of your main questions answered.  Questions like, ‘Is a home birth safe?’ ‘What do you do in an emergency?’ ‘Is my home left a mess after a home birth?’ are very normal questions to wonder about and ask.  Midwives have heard it all and will help you navigate some of the harder decisions you might be thinking about.

A couple of local midwife practices who hold regular Meet the Midwife meetings are

1. Elizabeth Reiner of Shifrah’s Sisters.  Elizabeth is a home birth midwife and holds monthly Meet the Midwife meetings.  Currently, with the Covid #stayathome order, she is holding them virtually. She serves Maryland, DC and NOVA, but is currently focusing on Maryland births during the pandemic days.  Look for her monthly Meet the Midwife on the last Wednesday of every month.
2. Premier Birth Center in Chantilly.  Premier Birth Center is covered by some local Virginia insurances and usually gives the option for home births or births at their birth center in Chantilly (and Winchester).  During recent days, they have been flooded with requests from families looking to transfer out of their hospital births, and have been focusing on birth center births to attend to all those who need it.  They hold multiple weekly Open Houses via Zoom- including a weekly one on Tuesday evenings with a midwife.

Know Your Home Birth Practice’s Statistics

The World Health Organization has recommended that cesarean rates for low-risk, vertex (head down) pregnancies range in the 10-15% range.  In the United States, our hospital births are ranging closer to 35% cesarean rates for low risk, first time, full-term, singleton births (NTSV). This is way above the WHO recommendations, and this is one of the reasons that many families seek out of hospital births.

Many local midwives are happy to share their annual statistics and in fact, publish them on their websites.  This is one of those pieces of information that it is harder to dig out of a hospital-based practice- but it is something that consumers should feel very comfortable requesting and have an absolute right to.  Below are some DC area local midwives who have shared their statistics online.  Going through these statistics can help you make a decision for which practice you choose to work with.  Looking at rates of cesareans and rates of hospital transfer can be especially indicative of which practice is the best fit for you.

• Fairfax Home Birth with Story Jones shares her practice statistics for the last 4 years here.
• Premier Birth Center share their 2019 practice statistics here.
• BirthCare (homebirth and birth center in Old Town Alexandria) shares some information towards the end of their Resources page linked here.  It does not make it clear whether these statistics are the most updated- I would call them for updated information.
• Del Ray Birth Collective shares her 2019 statistics on her Facebook page (scroll down to Jan 4th, 2020 posting).
• M.A.M.A.S Midwives, based in Takoma Park, share their statistics on Facebook (scroll down to the Feb 8th, 2020 post).

Diversity- Black Midwives & Midwives of Color in DC Metro Area

For many families, finding a midwife of color who is culturally competent, shares similar life experiences and understands their history is very important.  In the DC Metro area, there are a limited number of black midwives and midwives of color serving the hospital scene, and an even more limited number who serve the out-of-hospital scene.  (Regarding Muslim midwives- to the best of my knowledge, there are currently no Muslim midwives in the DC Metro area who work in the out-of-hospital scene.)  There are a number of midwives of color in training or who are recently trained and I look forward to seeing where they will practice.

• Safe Haven Midwifery with Casey Morrow– Home birth midwife.
• Blue Sage Midwifery with Aza Nedhari– At the current time, Midwife Aza Nedhari is a solo home birth midwife serving the DC Metro area.  Nedhari is a relatively newly certified CPM midwife who has been working extensively in the birth work scene with her non-profit serving the DC area- Mamatoto Village.
• BirthCare is owned by Marsha Jackson,  midwife, and has been operating since the mid-1980’s; one of the oldest out-of-hospital options in our area.  This midwifery practice has a number of other midwives that work there (none of the other midwives are midwives of color), and you rotate your prenatal visits between all of them. Births happen with whichever midwife is on call at the time.
• Premier Birth Center has a number of midwives on call, including one midwife of color at the current time.  Just like with BirthCare, you rotate your prenatal visits among the different midwives and whichever midwife is on call when you go into labor is the one who attends your birth.

Interview Different Practices

Finally, it really is important for you to make your decision based on your complete level of comfort and conviction.  Call different midwives, interview them, ask them about their experience and transfer rates, who they transfer to and what their transfer policy is.  Ask them about their safety measures.  Know that during these days of the Covid-19 pandemic, many of them are facing huge numbers of potential clients reaching out exploring the possibility of transferring their care from a hospital-based practice.  You may only find a limited number of midwives who are still accepting clients due in the next 2-3 months.

Decide what is most important to you- finances, safety, experience, transfer rates, a midwife who is culturally competent, a CNM (certified nurse midwife) vs a CPM (certified professional midwife) etc, and feel free to interview them and ask every question on your mind.  They take a limited number of clients each month and will give you the time and personalized attention you need.

Last But Not Least

I wanted to close off by mentioning that there are many other amazing home birth midwives which I did not link to here.  Some of these include a local CNM (certified nurse midwife) practice in the Loudoun area called Loudoun Home Birth and the practice of Midwife Casey Morrow here.

If you’re interested in exploring these options more, reach out to me for a 1-on-1 consultation to help you figure out what works best for you.