​What value would you put on having the experience you want instead of the one you are forced to have due to insurance requirements and constraints.  

It's rare for insurance to cover a home birth and not everyone has the money just sitting in the bank to cover a home birth midwife's fee. How can you find the money to cover a home birth? I have a few suggestions.

• Start saving for a home birth in a regular savings account. This option is available for everyone and can be a great way to get a head start on funding a homebirth, or to supplement HSA funds if needed. You can start funding the birth before baby is more than a twinkle in your eye.
• Use your Health Savings Account if your employer provides that option for you. HSA money can be spent to cover costs related to birth including home births. 
• Use a gift certificate. Some midwives may offer gift certificates so family and friends can support you in getting the birth you want. If the midwife doesn't offer gift certificates, she may be willing to if asked.
• Add funding for the home birth to your wish list for a baby shower.  
• Let family and friends know you are working to fund a home birth and would appreciate any help they can offer including financial help.
• Declutter and have a yard sale or sell things online.
• Bartering for all or a portion of the midwifery fee may be an option if the midwife is open to barter. 

Births are life changing events, just like weddings. Couples will plan out the details, and make the investment to have the wedding they want.  Births should be no different.  

Are you interested in getting the best value for your dollar? Would you like to have individualized maternity care?  Home birth midwifery care may be just what you are looking for.

Midwives have clients, not patients. Midwives do not offer assembly line care, instead they specialize in individualized care. Midwives want their clients to be fully informed so they can make the best decisions for themselves as an individual. Midwives want clients to ask questions, to share things they have learned and to be collaborators in their care. Midwives give generously of their time. Instead of a 10-15 minute appointment, you may get an hour or more of the midwife's sole focus at each appointment. In the area of Kansas I serve, if you have your baby at the hospital, whoever is on call is the doctor that will attend the birth. If you have been seeing an obstretrician for care, this may be a doctor you have never met before. Midwives don't pop in just in time to catch the baby and then leave shortly after.  With midwifery care, the midwife you hire is the midwife who will be at the birth (barring unusual situations). Midwives may spend several hours or even days supporting a client in labor, and will stay after birth for a few hours to be sure everyone is stable and doing well. Midwives do more than just a 6 week postpartum, most midwives will do 4 or more postpartum visits with the first two or more in the client's home. Some midwives have options to provide all their care in the client's home. When was the last time your doctor offered to come to your home?

If you don't have insurance and have to pay outright for a hospital birth in Kansas, you will be paying just shy of $11,000. My fee is less than 1/3 of that.  For many people, my fee is less than the insurance deductible they would have to pay for OB care and a hospital birth. You are not locked into using only the providers covered by health insurance, you can choose to pay directly for the provider you want. Choosing a provider is a bit like buying a car. You can get the base, no frills model or you can pay more to get extra options. With a home birth midwife, the cost is actually less to have more options and care tailored to you and your unique needs and situation. Home birth midwifery is luxury care, especially when compared to the assembly line care so prevalent in American maternity care.

Cervical checks are one of the mainstays of obstetric care.  It is not unusual to get checked around 38 weeks even though labor has not begun.  Then you get checked at the hospital while they are admitting you when you are in labor.  You might get checked more than a few times during labor.  Why all these checks? Do they tell how much longer you will be in labor? Are they risk free? Do you do cervical checks in your midwifery practice?

Let's start with the last question first.  I do not do cervical checks as part of routine care in my midwifery practice.  If a client asks me to do a check, we will discuss the risks and benefits of checking before I actually do a cervical check.  In all honesty, I prefer not to check.  I use external cues to assess how well labor is progressing, and those cues have served me well during my midwifery career.

What are the reasons for cervical checks anyway? Before labor begins, a provider may use a cervical check to assess how likely it is a pitocin induction will work.  Sometimes providers want to know if dilation has started before labor has begun.  A check when you are admitted to the hospital is done to confirm dilation is happening during labor and can also be to show insurance enough progress has occured to justify admitting you.  During labor, many providers have an assumption of how quickly you should be dilating, so they check to see if your body is conforming to their assumption.

Cervical checks do not tell you how much longer until your baby is born.  They tell the provider how dilated your cervix is in the moment, and potentially how your baby's head is positioned in your pelvis.  A cervix can be at 4 cm dilation, and baby could be born in the next 30 minutes or less, or a cervix can be dilated to 9 cm and labor may last another 6 or more hours.  Honestly, I think medical providers feel the need to check dilation because they are not staying with you in the hospital as labor progresses, so they don't have the opportunity for assessing progress by external cues.

Cervical checks do have risks.  Cervical exams increase bacterial levels in the vaginal canal which might lead  infection, especially after the membranes have ruptured.  Even with the most scrupulous hygiene, and wearing sterile gloves for each check, that risk does not go away.  There is a risk they may unintentionally rupture the amniotic sac.  Cervical checks are uncomfortable and may cause stress or anxiety, which can slow your labor.  Cervical checks are subjective, dilation is estimated because we can't use a measuring tape to get a precise number, and the estimation may vary between providers.  I have seen this personally when the nurse estimates dilation at 7 cm, and the doctor checks within 10 minutes and estimates dilation at 5 cm.  Hearing that you have gone backward after hours of labor can be disheartening to put it mildly, and can cause unneeded stress.

I like to watch and wait for the body to let my clients know when dilation is complete.  Because cervical checks are uncomfortable, intrusive, have risks and don't give me big picture info, I rarely use them.  As a midwife, I understand each birth has its own unique pace and rhythm and my job is to support and nurture that, not try to manage it.
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During my prenatal visits, and at the home visit, I ask my clients who is catching baby.  See, I do not have to catch baby.  I don't own that as a midwife, and I love providing guidance for another agreed upon person to catch baby.  I have helped Moms, Dads and Grandmas catch babies.

Once I know who is catching baby, we discuss what that will look like. I explain to them that I will be there right next to them talking them through everything if they want. I also let them know that if I see anything concerning, I will tell them  and I might need to step in.  I talk to them about what I do if the cord is wrapped around a neck or shoulder and that I will let tell them if I see signs of the cord being wrapped.  If I do see cord wrapping, I help whomever is catching baby navigate that, or if it is a really tight cord or a complicated wrapping, I will jump in to help with navigating that.

I love being able to guide Mom or Dad in catching their own baby.  I honestly think it is wonderful that the first hands to touch baby are Mom or Dad's and not mine. If there is a reason for me to help, I do so as quickly as possible and then get baby into Mom or Dad's hands right away. 

We have all seen the pictures of a provider who has just caught a baby holding baby up like a trophy for everyone to see.  Everytime I see a picture like that I cringe.  Baby should not be put on display even for one second, your baby should be in your arms as soon as they are born with no delays.  

In my practice, I fully support my clients who desire to have someone else catch the baby and I do everything in my power to let that happen.  It is so satisfying to me as a midwife to enable and support that choice for clients.

I am a firm believer that there is no such thing as "one size fits all". I can assure you "one size fits all" does not apply to gloves or pajamas and it certainly doesn't apply to midwives.  

We are all individuals with unique personalities, needs and desires. We all have unique backgrounds, upbringing, family history, and so on.  This is part of what makes life interesting.  Being unique means that what works for one person may or may not work for someone else.  Being unique also means we may connect more with one person, and not connect as well with someone else.  I feel this is normal, and perfectly ok.  

As a midwife, I want to connect with my clients and I want them to connect with me.  A huge factor in the safety of home birth is trust.  Trust in the birth process, and trust in mom's body is important.  Even more important, in my opinion, is trust in your birth team, especially your midwife.  As I attend more births, that need for trust in the birth team has become more and more evident to me.  The births where there is a lack of trust just don't seem to work as well as births where trust is overflowing.  

Before I agree to serve a client, I need to meet them in person.  This is the chance for the client to interview me and for me to interview them as well.  During the interview I am looking for a connection, understanding and respect.  With those things in place, trust can be nurtured. If they are not there, I am not the midwife for that client. I want the very best outcomes for my clients and families, so there are times I have to turn down someone who wants to hire me. Likewise, I have interviewed with prospective clients who decided to hire a different midwife. I'm thankful those Moms recognized they connected better with a different midwife. I want potential clients to know if they have any doubts, or do not feel a connection, they should continue looking for a midwife to find the one they connect well with.  Knowing I am not the midwife for everyone who is pregnant makes me a better midwife for everyone.