Homebirth

 

My Wood River Valley midwifery service provides a complete twelve months of nurturing and discerning maternity care from the first signs of pregnancy through the postpartum year. I believe that women’s bodies innately know how to give birth, and birth usually works best when women are given the freedom and privacy to let their bodies take over. I am continually humbled to be a witness and guide to women choosing to birth at home.

As a licensed midwife, I follow the standard schedule of prenatal care and offer routine medical testing and my practice is committed to centering women’s wisdom and bodily autonomy. I encourage clients to think critically about their choices and make decisions that honor their values and wishes for their babies and their births.

Midwifery is the US is practiced along a spectrum. I strive to be the midwife I would want for myself. I support the normalcy and sacredness of birth. Women’s unique life experiences and beliefs shape their context and I always want to meet women where they are at, with every step. You can count on my honest opinion when you ask me for it.

The following “basics” are included in the global midwifery package:

  • Prenatal care
  • Attendance at your labor and birth
  • Waterbirth tub
  • Nurturing and therapeutic bodywork throughout pregnancy and continuing after birth
  • In-home postpartum care for mother and baby for at least 6 weeks after birth.
  • Breastfeeding support,
  • Nourishing plant medicine

 

Midwives hold the space for women’s bodies to take over and do what they instinctively know how to do.

Prenatal Care

I believe that women are their own best care providers. Most of a woman’s prenatal care occurs in her everyday life, in the way she cares for her body and nourishes herself with food, exercise and ample rest. Mother and baby are an energetically entwined twosome — what is nourishing to mother is nourishing to baby.

I cherish my role as a gentle guide through the enormous transformation of pregnancy and birth. Too many women are entering their birthing time holding on to fear and anxiety about the unknown journey ahead. It doesn’t need to be this way. While some fear is healthy and normal, too much can become paralyzing and disembodying, taking women out of iolotheir rightful, mama bear birthing bodies. The heart of my prenatal care is helping women feel safe, honored, confident and and ready to have a joyful, physiologic birth.

My prenatal clinic visits typically last one and a half hours. After all the standard physical checks on mom and baby (including your choice of testing and interventions), we move right into to prenatal bodywork, addressing any aches and pains, encouraging optimal uterine and baby position, showering you with oxytocin, and leaving your pelvis mobile and balanced.

Prenatal visits also cover nutrition, herbal medicine and nourishing lifestyle choices.

 

 

“Birthing is the most profound initiation to spirituality a woman can have.”

   Robin Lim

My role at birth is to honor and affirm the mother’s work and process of labor, and to maintain a safe and nurturing environment that facilitates a spontaneous, physiologic birth experience.

Labor & Birth

 

When labor starts, women at home can ease into the rhythm of their contractions, nestled in their own familiar environment. They have the privacy and safety to turn inward and let their bodies take over and let their labor hormones flow without interruption. Oxytocin kicks in and women further surrender to the work of labor. They walk through the birth door, fully present and yet far away — in a totally primal, instinctual, wild consciousness. These are key ingredients for a normal, physiological birth process. Midwives help keep birth normal!

 

Once active labor has begun, I provide continuous care of mother and baby including vitals, ongoing fetal heart rate monitoring, as much hands-on / hands-off support as the mother desires. While the woman labors autonomously, I am monitoring for any deviations from normal. In order to provide the best care for mothers and babies, I always attend births with a skilled assistant or second midwife.

 

Most healthy women’s labors proceed normally and safely in their own time when not interfered with. Occasionally, assistance or intervention truly can be helpful for mothers and babies. Skilled midwifery care involves critical consideration of when such assistance is appropriate and will be helpful rather than detrimental.

 

After the birth I provide standard mother and newborn services including newborn exam, perineal repair, breastfeeding initiation and postpartum monitoring. I continue to facilitate a safe, loving space for mother and baby to fall in love. Unnecessary interventions are minimized. I remain at the home until mother and baby have bonded, breastfed successfully, and are tucked in for their first long sleep together, typically 4-6 hours after birth.

 

“A woman, as long as she lives, will remember how she was made to feel at her birth.”

Anna Verwaal

Postpartum Care

 

My practice embraces the physiologic, emotional and spiritual needs of women during the first months postpartum. This time can be overwhelmingly joyful, exhausting, and uncertain. Women are still solidly in their birth field for weeks and they have the best experiences and recoveries when they are not rushing about and leaving the house.

 

Home visiting is an extremely vital part of my postpartum care and I provide 3-5 home visits in the first ten days alone. Staying cozy at home keeps moms and babies grounded in their natural hormonal rhythms, which makes them a happier, healthier unit.

 

Ongoing physical assessment of mother and baby includes newborn weight checks, metabolic screening (PKU), congenital cardiac defect screening, and basic breastfeeding help for six weeks after birth.

 

In addition to standard midwifery, my clients continue to receive pelvic bodywork at every postpartum visit which I consider to absolutely vital to their mental and physical well-being. This including uterine balancing and massage, yoni steams and sitz baths, and closing the birthing pelvis. This work is deeply nourishing to the mother’s nervous system and helps her to integrate the birth experience on multiple levels.

 

I support women with every tool I have to help to help them feel safe, calm, and cared for. The attentive, intimate care reduces the incidence of breastfeeding challenges and postpartum depression and anxiety.

 

Healthy, happy babies who are nursing well can stay exclusively in my care for the first six weeks. I facilitate medical care for any mother or baby who is experiencing something abnormal or outside the scope of midwifery care.

What my clients say….

I am forever grateful to have had Erin as my midwife. She gave me the confidence and support needed to have a dream home birth experience! She is truly amazing!!! Professional, intuitive, calming, and dedicated to the process! She goes above and beyond to make you feel cared for and supported the whole way. I wish all women could experience pregnancy, birth, and postpartum care with the support of a midwife like Erin. I had my first two children in the hospital with standard prenatal care and I can say it was a completely different experience to have Erin for our third. I felt completely empowered and loved that we had choices! She was thorough and never rushed! By the end of my pregnancy she felt like family. Being tucked into my own bed with our new baby, warm blankets, Erin and family near was the best feeling in the world! Take it from a mom of three, this is definitely the way to go!

Laura Christ

At my very first visit I knew she was going to be the best choice for our family. She is so caring and we could see her passion in how she nurtured me to be the best I could be in health, physically and emotionally. We loved everything about our experience with her and would definitely choose to have her again!

Ashey Rosser

Erin holds a wealth of knowledge and wisdom in the field of women’s health, birthing and postpartum care. We had our first at home in Santa Cruz and while we loved our midwife there as well, I was so happy to have so much extra postpartum care with Erin — that doesn’t always exist! Thank you for helping us bring our second into the world. You are an amazing resource to this community! Tenaya Kolar

My family was fortunate to have Erin attend my son’s birth through the Bozeman Birth Center. We experienced her wisdom, gentle, caring down-to-Earth ways. Anyone who has a chance to work with Erin will be blessed.

Betsy Knox Meyer

Frequently Asked Questions

I am seeing a doctor for prenatal cared was planning a hospital birth. Is it too late to consider having a midwife-attended homebirth?

It is never too late to switch care providers. It is never too late to change your plans, or to start making decisions that feel more aligned with your values and desires. It is actually quite common for women to transfer to a new care providers when their needs change. After all, you are the consumer. Each woman possesses the autonomy and wisdom to know which birthing environment feels best for her — even if it’s late in the game. It is your body, your birth, your baby, your choice.

I am over 35 and was told I am "high-risk." Does that mean I can't have a homebirth?

No. Almost half of my clients have been over 35. The age of 35 was designated as the beginning of the “high-risk” age bracket NOT because of a significantly increased risk pregnancy or birth pops up at the magoc age of 35, but because of the nature of amniocentesis; At age 35, the chance of having a baby with Down’s syndrome is the same as the chance of having a miscarriage as the result of an amniocentesis. Mothers aged 35 and older were assumed to want genetic testing and amniocentesis was teh best available tool a few decades ago. Being 35 or older does not automatically make a mother “high-risk.” Indeed, the “older moms” in my practice are often the healthiest moms!

I experienced a complication in a previous pregnancy or birth. Does this mean I am too high-risk to have a homebirth this time?

This depends on the specific condition and the circumstances of the previous pregnancy. Many “complications” experienced in previous pregnancies or births result from interventions initiated by the care provider. Other complications are seemingly more random. In general, complications in pregnancy and birth do not repeat themselves, and are often prevented in future pregnancies and birth by maternal efforts, chance, or more woman-centered care on the part of the provider. During the consult or initial visit we discuss your reproductive and birth history in detail. We discuss at length the risk of the previous condition and any measures we can take to prevent it this time around. If we determine that the circumstances of your pregnancy are beyond my comfort level or experience, or are indeed high-risk, I will help you find another midwife or physician.

What if I want an ultrasound or other tests?

I offer all of the standard routine prenatal and postpartum tests for you and your baby. Referrals are made for ultrasound and some genetic testing. I make every attempt to refer you to a homebirth-friendly provider who supports women’s informed decision-making.

Do I need to see a doctor before starting midwifery care and planning a homebirth?

No. Midwives are primary care providers and provide complete maternity care to women having healthy pregnancies. Midwives use the same lab tests physicians use. If ultrasound is needed or desired for dating a referral is made. Midwives are trained to identify potential complications and deviations from normal. In these cases, midwives consult with or refer care to more specialized providers (obstetricians, perinatologists, pediatricians, etc.).  Below are some of the more common conditions requiring transfer of care to a physician or hospital.

Placenta previa

Preexisting high blood pressure not controlled by diet, exercise and medication

Pre-existing diabetes (this is different from “gestational diabetes”)

Heart, kidney or lung disease

Alcoholism or drug abuse or addiction

Preeclampsia

Preterm birth (before 37 weeks)

The baby’s umbilical cord prolapses when the water breaks

Baby has a non-reassuring heart rate or pattern during labor

Mother is unable or unwilling to take responsibility for her prenatal care and well-being

Is homebirth safe? What if something goes wrong?

Scientific research on maternal and neonatal outcomes over the last four decades clearly demonstrates that planned homebirth and birth center birth with trained midwives is at least as safe as hospital birth attended by OBs, if not safer. No study has ever demonstrated that hospital care is safer for low-risk women. There are no studies demonstrating that births attended by obstetricians are safer than births attended by midwives for normal pregnancy and birth. Most other developed nations use midwives as the primary care providers for the childbearing year and midwife-attended homebirth is common and recognized and promoted as excellent care (Eg., Canada, UK, Australia, New Zealand, most Scandinavian countries, the Netherlands, and Japan). About 20% of babies in the Netherlands are born at home with midwives. The UK national health care system is working to get low-risk women out of the hospital and into homes and birth centers to have their babies; The obstetricians are recognized as specialists in high-risk pregnancies and the midwives are recognized as experts in normal childbearing. MANA has a user-friendly Annotated Guide to the studies on midwifery care and homebirth.

Are there any differences between prenatal care with a Licensed Midwife and prenatal care with an OB/GYN, or nurse-midwife in the hospital?

Yes, there are many significant differences. One is time. Prenatal visits with homebirth midwives generally last about an hour and mine tend to last closer to one and a half hours. The clinical portion of a prenatal visit (taking mother’s vital signs, listening to heart tones, feeling baby’s position, etc.,) only takes about 7 minutes! The rest of the time we devote to getting to know our clients — their needs, desires, hopes, fears. Longer prenatal visits give us the time to become comfortable with each other, to build trust, and to allow our relationship to grow over time. I welcome and encourage you to discuss any and all questions and concerns during your prenatal visits! Additionally, homebirth midwives do not generally have a one-size-fits-all approach to prenatal care; We do not insist every woman have the same standard screening tests and procedures. Midwives believe that you are the best decision-maker for you and your baby. You are in the driver’s seat. Take a look at the Benefits of Homebirth page for more information on my site. Other good links on what makes midwifery care excellent care are Models of Maternity Care – Our Bodies Ourselves and Childbirth Connection’s guide to choosing care providers.

Will insurance or medicaid pay for homebirth?

Many insurance companies will pay for out-of-hospital midwifery care. Some states have passed laws requiring private insurance companies to pay for any and all licensed providers in that state. Idaho does not have such a law; I recommend clients with private insurance verify coverage with their carriers. Medicaid DOES pays for homebirth and birth center birth in Idaho.
I am committed to having an out of hospital birth, but I don’t have insurance or Medicaid, and I don’t know if I can afford to pay out-of-pocket.

What if there is a complication during my labor or birth?

Most complications during labor and birth are not true emergencies. They are more like road bumps, and are easily are recognized in advance by a skilled provider and can be safely resolved at home. Occasionally, more specialized procedures and treatments in the hospital are helpful or necessary for these non-urgent complications. Skilled and thorough prenatal care also greatly diminishes the chances of more urgent complications in labor (hemorrhage, breech, preeclampsia, etc.).  In the rare instances urgent complications do arise, midwives are trained to quickly recognize and respond to any deviations from normal. This is, of course, why most women hire birth attendants — to recognize and assist conditions and complications that warrant quick intervention. Midwives are trained and prepared to manage and stabilize emergent situations. This is one of the reasons we have such an excellent safety record attending low-risk women at home.

When transfer to the hospital is necessary, I always accompany mothers and families to facilitate their transition to either a nurse-midwife or physician. Every attempt is made to transfer to our consulting obstetricians or other homebirth-friendly OBs or CNMs. (All clients are assisted in making a hospital transport plan toward the end of pregnancy). At the hospital I am no longer the primary care provider but I do attempt to provide collaborative care with the physician or nurse-midwife when appropriate. I continue to advocate for your safe and humane treatment and discuss with you the risks and benefits of any proposed procedures and treatments. I stay with mothers through the birth and first hours postpartum.

It is important to recognize that complications arise in the hospital as well. In healthy, low-risk women, these complications are often the direct result of some intervention, medication, or protocol used during the labor or birth. So, we must look at the whole picture. There are risks inherent in childbirth no matter where a woman gives birth. There are risks at home and there are risks at the hospital. Each place possess a different set of risks. For example, when a woman gives birth at home she faces the very rare possibility that an emergent complication may arise. When a woman gives birth in the hospital she faces many risks for trauma and morbidity including a 1 in 3 chance of having a cesarean section which carries a much higher mortality and complication rate than vaginal birth. Ideally every pregnant woman must consciously assess these risks for herself. Our job as healthcare providers is to inform women of the real set of risks she will encounter both in the hospital and at home.

Are you against doctors or hospital birth?

No! In fact, I chose to use medical assistance in a hospital during my first birth. As a surgical specialty, the field of obstetrics has contributed life-saving procedures to maternity care, namely cesarean section. These procedures and surgeries can save lives and improve outcomes for a small but significant percentage of women and babies. I am grateful for the specialized care OB/GYNs have to offer — they are a vital and necessary part of the maternity care system. I am also grateful for the availability of hospital birth for women who make the informed, conscious choice to birth there,  and for the women and babies for need to birth there for the safest possible outcomes. In my twelve years of attending births I have witnessed many beautiful hospital births, most of them occurring at the University of New Mexico Health Sciences Center. I am fortunate to have had supportive relationships with physicians in the past and I hope to continue to develop new relationships with physicians and CNMs in the future.

(What I am opposed to is sacrificing normal, healthy birth and women’s autonomy in favor of institutional/physician protocol and convenience. These two forces are the primary contributors to the cascade of interventions that befall most birthing women, driving up the rate of unnecessary cesareans, and often leaving women feeling traumatized and victimized postpartum.)

I want to have a homebirth but I don't think my partner will be on board....

Women need their partners’ support in pregnancy and birth. Without it, everything is harder at a time when you should be honored, nurtured and taken care of. I encourage couples to come in together for a free consult visit to get a sense of what midwifery care is all about. I find that when partners are able to ask questions and investigate midwifery care for themselves, they begin to see how wonderful and safe the individualized care is. As partners become more comfortable with the process of informed decision-making, they usually begin to understand and value your needs and choices more.

I don't know anyone who has had a homebirth. What are your clients like?

Women of all walks of life. All cultures, races, ages, faiths and incomes. My clients have ranged from 17 to 43 years old, and have been Christian, Atheist, Muslim, Pagan, Lesbian, Korean, British, Phillipino, single, divorced, GED students, homeschoolers, unschoolers, PhD scientists and everything in between. Homebirth families are in most communities – you’ll find them one you start to look.

Homebirth is so much more popular in Europe and other countries around the world. Why don't more women in the United States give birth at home?

In the United States there are many obstacles to having a midwife-attended birth outside the hospital: political, social, economic, psychological, and so on. Many people are not aware that they have a choice in care beyond OBs and nurse-midwives. Midwifery is not legally recognized at the federal level — individual states maintain laws regulating or prohibiting the practice of midwifery. That’s right, midwifery is still illegal in some states on account of antiquated anti-midwife laws. In these states homebirth midwifery exists largely underground and is difficult to access. Woman living in these places are often unaware of any alternative to hospital birth, and the midwives practice in fear of felony criminal charges and imprisonment. Many communities do not have any out-of-hospital midwives. Most states do not require Medicaid or private insurance to pay for care, and many families cannot afford to pay out-of-pocket for maternity care. Midwifery is truly a calling for many midwives and their compensation often barely covers their time and expenses. Midwives struggle financially too and it is often difficult for them to keep practicing. They do not have the overhead to match the types of advertising hospital-based providers have. As a profession we lack the capital and political power that the obstetrics industry has; we have been marginalized for many decades and we have far fewer numbers. Finally, as a whole, the field of obstetrics continues to promote the myths that hospitals are the safest places to birth babies and that physicians are the safest providers for healthy, low-risk women. This myth has been integrated into our society all the way up to the Capital steps and our legislators have a hand in perpetuating it to boot. Someday soon the maternity care crisis will force the US healthcare system to catch up to the rest of the world, and recognize the wisdom and safety of giving birth at home with a midwife.