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

While 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. Honoring the dynamic of “Motherbaby” is a cornerstone of an embodied and instinctive pregnancy and birth.

My role is to be a gentle guide through the enormous transformation of pregnancy. My goal is for the women in my care to feel nurtured in their pursuit of connection– connection to their deepest selves, connection to their womb and pelvic, and connection to their babies. The heart of my prenatal care is helping women feel safe, honored, confident and ready to have a joyful, physiologic birth. Success in my practice is when a woman feels like she could have done it all on her own.

My prenatal clinic visits typically last one and a half hours. My clients and I have time to grow into a trusting relationship in which they are in the driver’s seat. After all the standard physical checks on mom and baby (including any tests of your choice), we move 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 profound physiologic, emotional and spiritual needs of women after birth. It is a unique time in women’s lives that they will never experience again with that particular baby. This time can be overwhelmingly joyful, exhausting, and uncertain. Women are still solidly in their birth field for a couple of months and their nervous systems and bodies are operating at much slower than normal pace. They need time and rest to integrate the birth process and begin making milk. New mothers have the best experiences and long-term recoveries when they are lovingly tended to cozied up at home (rather than rushing about and leaving the house with a baby in tow). This keeps mom grounded in their hormonal rhythms and grounded in their bodies, which makes Motherbaby a happier, healthier unit.

Home visiting is an extremely vital part of my postpartum care and I provide 4-5 home visits in the first two weeks after birth, plus additional visits through six weeks. 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 care, my clients continue to receive pelvic bodywork through the postpartum period. This is absolutely vital to their mental and physical well-being. Abdominal and uterine massage, sitz baths, pelvic hydrotherapy/steam and pelvic balancing are integrated throughout the six weeks postpartum. 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. 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.

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. 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 care and 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 make choices that are aligned with your values and desires. It is actually quite common for pregnant women to transfer to a new care provider as their needs and preferences change. You are the consumer of the maternity care you choose. 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 baby, your birth.

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. A long time ago, the age of 35 was designated as the start of the “high-risk” cutoff because of the nature of the amniocentesis test, which at one time had been the primary genetic screening test for Down’s Syndrome. At age 35, the chance of having a baby with a genetic problem like Down’s Syndrome was higher at that point than the same as the chance of having a miscarriage from the amniocentesis test. (Losing the baby is a possible consequence of doing amniocentesis). Mothers aged 35 and older were assumed to want genetic testing and amniocentesis was the best available tool many decades ago. While some genetic abnormalities do increase with age, being 35+ does not automatically make a particular woman “high-risk.” Indeed, the “older moms” in my practice are often the healthiest moms! We will talk at length about the risks to you and your baby as well as all of your testing options during your initial visit.

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 lifestyle choices, 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, the likelihood it would happen again, and any measures we can take to prevent it this time around, if possible. If we determine that the circumstances of your pregnancy are beyond my comfort level or experience, or are truly high-risk, I will help you find another woman-centered midwife or physician.

Do you DO ultrasounds AND other tests?

I offer all of the standard routine prenatal and postpartum tests for you and your baby including ultrasound scans and genetic testing. The choice to have an ultrasound or do any special tests is always up to you. You are the primary decision-maker for your pregnancy and your baby. Referrals to Boise specialists are made for certain types of ultrasound and genetic tests. 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 maternity care providers. We offer complete prenatal, birth and postpartum care to women having healthy pregnancies. Midwives use the same lab tests physicians use. 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.).  A woman man stay in co-care with a midwife and physician, or in some truly “high-risk” instances she may be required to transfer to medical management.

Below are some of the more common conditions for which that the state of Idaho requires 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, low-risk homebirth and birth center birth with trained midwives is at least as safe, if not safer, than hospital birth attended by OBs. The use of routine interventions and cesarean section are considerably lower with midwives at home, reducing the risk to mother and baby. 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 including Canada, the UK, Australia, New Zealand, Japan, The Netherlands, and most Scandinavian countries use midwives as the primary care providers for the childbearing year. Midwife-attended homebirth is common in these places and promoted as excellent care. 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 birth. The Midwives Alliance of North America (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?

 There are many significant differences. The first major difference is the model of care. In the medical model of maternity care, pregnancy and birth are risky processes that require medical management and standardization to go well. Testing and medications are routine. A woman has a 1 in 3 chance of having a cesarean birth (sometimes 1 in 2). The system is designed to try to provide uniform care to all women so that providers, hospital staff and protocols are all on the same page. In the midwifery model of maternity care, pregnancy and birth are honored as normal biological processes designed by nature to be successful the vast majority of the time without messing with it– and that messing with it actually creates problems. Women are not expected to comply with protocols for the sake of the system or provider beliefs and preferences; All testing and procedures are your call and all options are discussed at length. Midwives recognize that each woman is having a unique experience of pregnancy and birth and that attempts to standardize this process prevent her from having a fully embodied and self-directed experience. It is a woman’s birthright is to experience the joys and ecstatic power nature provides us through physiologic birth and mothering. When a woman is the primary decision maker for herself and her baby she accesses her full range of experience. She and her baby are safest, and mothering begins from a place of empowered knowing, triumph, and love.

Take a look at my 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.

A second primary difference between the models is time and intimacy. Prenatal visits with homebirth midwives generally last about an hour and mine tend to last closer to two 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 allow us to develop a relationship free from top-down power dynamics. Trust and intimacy grow with time, compassion, and respect for a woman’s inner wisdom.

Additionally, and this is a huge bonus, I provide pelvic bodywork at almost every prenatal visit and into the postpartum period. Specifically this work addresses problems in the pelvis that may hinder normal labor birth. I will help optimize your pelvic mobility, encourage the best position for baby, and help your body with any of the typical pregnancy aches and pains. We may also work on the emotional body in preparation for birth. See the Pelvic Care page for details.

Will insurance or medicaid pay for homebirth?

Some 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. I no longer bill insurance directly because of the very deep flaws in the system. I do provide you with a superbill after the birth to submit on your own should you choose. Sometimes with lots of dedicated follow-up women can get reimbursed and there are guides online to walk you through this. Medicaid does pays for homebirth and birth center birth in Idaho. If you are committed to having an homebirth, but cannot pay out-of-pocket please discuss with me. Usually we can find a way to make it happen, between a sliding scale payment plan or trade.

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 can arise and 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 homebirth-friendly providers. (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 necessitating a cesarean, or NICU. 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. Our local hospital also does not care for sick babies and all babies who need special ongoing evaluation and care are transported to Boise. 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! I am grateful for medical care when needed. In fact, I chose to use medical assistance 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.  Obstetrics is 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 20+ 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 the importance of not only valuing but prioritizing your needs and choices. Partners begin to see that honoring and prioritizing your innate wisdom, intuition and needs are what will lead you through the most safe, embodied, and joyful birthing experience.

I don't know anyone who has had a homebirth. Is this some throwback hippy shit?

Women of all walks of life choose to have community births. 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 once you start to ask!

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 community birth: political, social, economic, psychological, and legal. Many women are unaware that they have the choice give birth at home, or that there midwives to help them. 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 have significant overhead with running a small business in addition to actually doing the work of midwifeing, plus maintaining legal and professional fees and continuing education. Most midwives cannot match the advertising of hospitals and hospital-based providers. 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.

It is beyond the scope if this answer to dive into the race and class issues that affect access to community birth but they are huge. Midwifery care is still largely accessed by white women with higher education levels. Much work is being done to bring equity to midwifery and to train many more midwives of color but institutional, social and legal obstacles abound.

Finally, as a whole, the medical-industrial complex coopted normal birth from women and midwives in the 1900s and we have never recovered. Women have never recovered. Confidence in the ability to give birth normally and trust in a woman’s innate knowing to guide her through was replaced with alienation and fear of birth. Physicians were perceived to know what was best for women in the birth room and power was taken, and handed over. Today, 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. 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, safety, and biological normalcy of giving birth at home with a midwife the natural way.